Provider Demographics
NPI:1033116454
Name:WILLIAMS, FRED C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:WILLIAMS
Suffix:JR
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 1:1200 NE 48TH AVE
Mailing Address - Street 2:STE 1100
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-4904
Mailing Address - Country:US
Mailing Address - Phone:503-844-8219
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 48TH AVE
Practice Address - Street 2:STE 1100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-4904
Practice Address - Country:US
Practice Address - Phone:503-844-8219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24895207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297679Medicaid
ORE85970Medicare UPIN
OR297679Medicaid