Provider Demographics
NPI:1346356607
Name:WILLIAMS, ALAN LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LEWIS
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 1:2020 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-3120
Mailing Address - Country:US
Mailing Address - Phone:916-341-0575
Mailing Address - Fax:
Practice Address - Street 1:2020 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-3120
Practice Address - Country:US
Practice Address - Phone:916-341-0575
Practice Address - Fax:916-341-0192
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC53753OtherCA PHYSICIAN AND SURGEON LICENSE
MDM55181OtherSTATE CDS
MDD0060551OtherSTATE LICENSE
MDM55181OtherSTATE CDS
MDI01758Medicare UPIN