Provider Demographics
NPI:1366542896
Name:WILLIAMS, ELWOOD FRAY (MD)
Entity type:Individual
Prefix:
First Name:ELWOOD
Middle Name:FRAY
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 1:5401 N PORTLAND AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2121
Mailing Address - Country:US
Mailing Address - Phone:405-604-4210
Mailing Address - Fax:405-604-4241
Practice Address - Street 1:5401 N PORTLAND AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1670
Practice Address - Country:US
Practice Address - Phone:405-604-4210
Practice Address - Fax:405-604-4241
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17492207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112650AMedicaid
OK290004188OtherRAILROAD MC
OKB31186Medicare UPIN