Provider Demographics
NPI:1780183210
Name:WILLIAMS, PERCIVAL (RT)
Entity Type:Individual
Prefix:
First Name:PERCIVAL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9620
Mailing Address - Country:US
Mailing Address - Phone:831-420-7105
Mailing Address - Fax:
Practice Address - Street 1:6885 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-9620
Practice Address - Country:US
Practice Address - Phone:831-420-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT729162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology