Provider Demographics
NPI:1023009040
Name:WILLIAMS, VICTOR BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:BERNARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 5589
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-5589
Mailing Address - Country:US
Mailing Address - Phone:501-280-0499
Mailing Address - Fax:501-217-0222
Practice Address - Street 1:9712 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2124
Practice Address - Country:US
Practice Address - Phone:501-280-0499
Practice Address - Fax:501-217-0222
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-2372208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150104001Medicaid
ARH91479Medicare UPIN
ARH91479Medicare UPIN