Provider Demographics
NPI:1760468003
Name:WILLIAMS, MARSHALL FAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:FAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9460 N NAME UNO
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3537
Mailing Address - Country:US
Mailing Address - Phone:408-842-3133
Mailing Address - Fax:408-842-2229
Practice Address - Street 1:9460 N NAME UNO
Practice Address - Street 2:SUITE 115
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3537
Practice Address - Country:US
Practice Address - Phone:408-842-3133
Practice Address - Fax:408-842-2229
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG45805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G458050Medicare PIN
A50192Medicare UPIN
CAP00030234Medicare PIN