Individual provider Active NPI

Robert D Williams, MD

  • Family Medicine Physician
  • Draper, UT
National Provider Identifier
1063596401
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1855221205 Issued in UT
Practice address
11724 S State St
Draper, UT 84020-7163
Phone
(801) 965-3600
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1855221205 UT Primary

Addresses

Primary practice location

11724 S State St
Draper, UT 84020-7163

Mailing address

2965 W 3500 S
West Valley City, UT 84119-3602
Phone (801) 965-3600

Other identifiers 1

IdentifierTypeStateIssuer
11348MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080227000140 UT Practitioner - Family Practice 0749364941 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1855221205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Specialists LLC CurrentSince Nov 6, 2023 Accepting new patients
Granger Medical Specialists, LLC CurrentSince Nov 6, 2023 Accepting new patients
Granger Medical Clinic PC CurrentSince Dec 27, 2023 Accepting new patients
Granger Medical Clinic PC Family Medicine Current Accepting new patients

Locations

11724 S State St
Draper, UT 84020
Phone (801) 576-2000

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

1288 W 12700 S
Riverton, UT 84065
Phone (801) 253-3500

995 W Levoy Dr
Taylorsville, UT 84123

7181 S Campus View Dr
West Jordan, UT 84084
Phone (801) 965-3505

3725 W 4100 S
West Valley City, UT 84120
Phone (801) 965-3545

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1063596401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11724 S STATE ST",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207163",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "ROBERT",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "1855221205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11348",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

Verify at the official NPI Registry.