Provider Demographics
NPI:1225289788
Name:RICHARD B WILLIAMS PHD MD INC
Entity Type:Organization
Organization Name:RICHARD B WILLIAMS PHD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-799-3616
Mailing Address - Street 1:PO BOX 800817
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-0817
Mailing Address - Country:US
Mailing Address - Phone:661-295-0859
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:630 MISSION ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3038
Practice Address - Country:US
Practice Address - Phone:626-799-3616
Practice Address - Fax:626-799-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPRESIDENT LICENSE#OtherG58242