Individual
DR. JEFFREY WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1500 SALEM ST, LAFAYETTE, IN 47904-2164
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002139A
IN
207Q00000X
Family Medicine Physician
34006949W
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000177576
UNISON PIN
—
01
—
000000185151
ANTHEM PIN
—
01
—
000000873283
ANTHEM PROVIDER NUMBER
IN
01
—
0110615
UHC PIN
—
01
—
080157683
MEDICARE RAILROAD
—
01
—
0989499
GROUP MEDICAID
OH
05
—
201219650
—
IN
05
—
2187011
—
OH
01
—
311413469041
CARESOURCE PIN
—
01
—
CA1586
GROUP MEDICARE RAILROAD
—
Enumeration date
12/28/2005
Last updated
11/18/2014
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