Provider Demographics
NPI:1659328631
Name:WILLIAMS, THEODORE G (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17150 NEWHOPE ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4250
Mailing Address - Country:US
Mailing Address - Phone:714-437-7400
Mailing Address - Fax:714-437-7410
Practice Address - Street 1:1300 BRISTOL ST N
Practice Address - Street 2:SUITE 175
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2951
Practice Address - Country:US
Practice Address - Phone:714-437-7400
Practice Address - Fax:714-437-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA230872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23087OtherSTATE LICENSE