Provider Demographics
NPI:1093703357
Name:WILLIAMS, WENDELL BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:BRYAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5900 SHATTUCK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1461
Mailing Address - Country:US
Mailing Address - Phone:510-595-1500
Mailing Address - Fax:510-595-1560
Practice Address - Street 1:5900 SHATTUCK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1461
Practice Address - Country:US
Practice Address - Phone:510-595-1500
Practice Address - Fax:510-595-1560
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA72340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH34302Medicare UPIN