Provider Demographics
NPI:1982604369
Name:WILLIAMS, ROY JEROME JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:JEROME
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-261-4834
Mailing Address - Fax:314-383-3930
Practice Address - Street 1:3409 UNION BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1127
Practice Address - Country:US
Practice Address - Phone:314-261-4834
Practice Address - Fax:314-383-3930
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA12333Medicare UPIN
MO124510034Medicare PIN