Provider Demographics
NPI:1548685902
Name:WILLIAMS, ROBERT REX (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:REX
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11102 SUNRISE BLVD E
Mailing Address - Street 2:STE 103
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8846
Mailing Address - Country:US
Mailing Address - Phone:253-848-8797
Mailing Address - Fax:
Practice Address - Street 1:11102 SUNRISE BLVD E
Practice Address - Street 2:STE 103
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8846
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical