Mark D. Williams, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

29945 Issued in AZ

Practice address

803 S Ponderosa St
Suite C
Payson, AZ 85541-5521

Phone

(928) 472-1222

Fax

(928) 472-1213

NPI assigned

Nov 21, 2006

Last updated

May 22, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Banner-University Medical Group

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1508809427

  Family Medicine

  NPD (past)
• FCHC Medical Care, LLC

  • Multi-Specialty Clinic/Center
  • Wauseon, OH
  • NPI 1598821175
  NPD (past)
• Licking Memorial Professional Corporation

  dba Licking Memorial Orthopedic DME

  • Durable Medical Equipment & Medical Supplies
  • Newark, OH
  • NPI 1326436510
  NPD (past)
• University Surgery Associates, PLLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Jackson, MS
  • NPI 1356451652
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432252800000",
    "number": "1629143144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 BUCKS LAKE RD",
            "city": "QUINCY",
            "state": "CA",
            "postal_code": "959719507",
            "telephone_number": "530-283-2121",
            "fax_number": "530-283-7953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S PONDEROSA ST",
            "address_2": "SUITE C",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415521",
            "telephone_number": "928-472-1222",
            "fax_number": "928-472-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MARK",
        "middle_name": "D.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2015-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "29945",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "AZ",
            "license": "29945",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G88791",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "646490",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chandra Wattleworth
• Karl Watts
• Mark Westberg, PHARM D.
• Jaegar Dean White, MD
• Charles R. Williams, DC
• Leroy Wombold, DO
• Danielle Thomas Woods, LPC
• Kristin Ann Woods, FNP
• Victoria L Woods, LCSW
• Paul T Yoder, MD

• Surgery Physician in Payson, AZ
• Providers in Payson, AZ by specialty
• Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.