Provider Demographics
NPI:1396857850
Name:WILLIAMS, ROBERT C (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40238 107TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEONA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93551-7306
Mailing Address - Country:US
Mailing Address - Phone:661-270-1173
Mailing Address - Fax:661-270-1173
Practice Address - Street 1:40238 107TH ST W
Practice Address - Street 2:
Practice Address - City:LEONA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93551-7306
Practice Address - Country:US
Practice Address - Phone:661-270-1173
Practice Address - Fax:661-270-1173
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3242213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E32420Medicaid
CA5228840001OtherDMERC
CAT11595Medicare UPIN
CA000E32420Medicaid
CAE3242CMedicare ID - Type Unspecified