Provider Demographics
NPI:1235277195
Name:WILLIAMS, LYTTON A (MD)
Entity Type:Individual
Prefix:
First Name:LYTTON
Middle Name:A
Last Name:WILLIAMS
Suffix:
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 1:2200 W 3RD ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1932
Mailing Address - Country:US
Mailing Address - Phone:213-207-5635
Mailing Address - Fax:213-207-5889
Practice Address - Street 1:2200 W 3RD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1932
Practice Address - Country:US
Practice Address - Phone:213-207-5635
Practice Address - Fax:213-207-5889
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40156207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14159Medicaid
CAA48112Medicare UPIN
CAW14159Medicaid