Provider Demographics
NPI:1174734602
Name:WILLIAMS, BRUCE PARMER (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:PARMER
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 1:4101 HECKEL RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-7328
Mailing Address - Country:US
Mailing Address - Phone:812-479-8411
Mailing Address - Fax:
Practice Address - Street 1:4101 HECKEL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7328
Practice Address - Country:US
Practice Address - Phone:812-479-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025479A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000214978OtherANTHEM
IN100245930BMedicaid
IN100245930BMedicaid