Provider Demographics
NPI:1548329634
Name:WILLIAMS, CLYDE H III (MD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:H
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2222 N NEVADA AVE
Mailing Address - Street 2:SUITE 4004
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6832
Mailing Address - Country:US
Mailing Address - Phone:719-471-7064
Mailing Address - Fax:719-776-5459
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:SUITE 4004
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6832
Practice Address - Country:US
Practice Address - Phone:719-471-7064
Practice Address - Fax:719-776-5459
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO21615207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO290000688OtherRAILROAD MEDICARE
CO01216159Medicaid
COC16324Medicare PIN
E22852Medicare UPIN