Provider Demographics
NPI:1023002151
Name:HOUSE, MARIA WILLIAMSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:WILLIAMSON
Last Name:HOUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9348
Mailing Address - Country:US
Mailing Address - Phone:719-648-3595
Mailing Address - Fax:
Practice Address - Street 1:100 MISSION BLVD STE B116
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2536
Practice Address - Country:US
Practice Address - Phone:209-217-8416
Practice Address - Fax:209-217-8433
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148178208C00000X, 208600000X
MI4301099492208600000X, 208C00000X
CO38764208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C461848Medicare PIN
COCOA101880Medicare PIN