Provider Demographics
NPI:1053427567
Name:WILLIAMS, THEOPOLIS CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:THEOPOLIS
Middle Name:CHARLES
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENE ORCHARDS OFFICE , 7101 NE 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-4933
Mailing Address - Country:US
Mailing Address - Phone:360-420-2244
Mailing Address - Fax:360-418-6007
Practice Address - Street 1:KAISER PERMANENE ORCHARDS OFFICE , 7101 NE 137TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-4933
Practice Address - Country:US
Practice Address - Phone:866-420-2244
Practice Address - Fax:360-418-6007
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA MD00025823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine