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Individual

WALTER LEROY WILLIAMS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1433 5TH ST., CLARKSTON, WA 99403-2714
(509) 758-5141
(509) 758-5299
Mailing address
1433 5TH ST., CLARKSTON, WA 99403-2714
(509) 758-5141
(509) 758-5299

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
MD00041565
WA
207N00000X
Dermatology Physician
Primary
MD00041565
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010139009
REGENCE BLUE SHIELD PROV.
ID
01
030734610
PREMERA BLUE CROSS #
WA
01
1117878
WASHINGTON MEDICAID #
WA
01
72157
BLUE CROSS OF IDAHO
ID
05
806377300
ID
01
MD00041565
WASHINGTON LICENSE
WA
01
P00007739
RAILROAD MEDICARE #
WA
Enumeration date
03/16/2006
Last updated
03/15/2024
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