Individual
MICHAEL DEREK WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 NE 28TH ST STE E, LINCOLN CITY, OR 97367-4524
(541) 994-8114
(541) 994-5679
Mailing address
PO BOX 1194, CORVALLIS, OR 97339-1194
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
53236
MN
208600000X
Surgery Physician
Primary
DO198440
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
10/01/2009
Last updated
11/04/2020
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