Provider Demographics
NPI:1386677102
Name:WILLIAMS, LEON DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:DOUGLAS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5524 ASSEMBLY CT
Mailing Address - Street 2:SACRAMENTO COMMUNITY CLINIC - AC
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2625
Mailing Address - Country:US
Mailing Address - Phone:916-642-1867
Mailing Address - Fax:
Practice Address - Street 1:6450 LOUISIANA HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:INNIS
Practice Address - State:LA
Practice Address - Zip Code:70747
Practice Address - Country:US
Practice Address - Phone:225-492-3775
Practice Address - Fax:225-492-3782
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA200787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1071056Medicaid