Provider Demographics
NPI:1467405753
Name:WILLIAMS, DEREK FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:FRANK
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11633 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2321
Mailing Address - Country:US
Mailing Address - Phone:310-792-4450
Mailing Address - Fax:310-792-4455
Practice Address - Street 1:11633 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2321
Practice Address - Country:US
Practice Address - Phone:310-792-4450
Practice Address - Fax:310-792-4455
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA72933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G157110Medicaid
CABW5415799OtherDEA NUMBER
CABW5415799OtherDEA NUMBER