Provider Demographics
NPI:1083756613
Name:JANE WILLIAMS, M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JANE WILLIAMS, M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-840-0758
Mailing Address - Street 1:PO BOX 994032
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4032
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:
Practice Address - Street 1:1225 CENTRAL AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4390
Practice Address - Country:US
Practice Address - Phone:707-840-0758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG15387Medicare UPIN