Provider Demographics
NPI:1790864767
Name:WILLIAMS, BRIAN A (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N PALM CANYON DR # 203 204
Mailing Address - Street 2:
Mailing Address - City:PALM SPGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-320-1199
Mailing Address - Fax:760-323-2769
Practice Address - Street 1:1100 N PALM CANYON DR # 203 204
Practice Address - Street 2:
Practice Address - City:PALM SPGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-320-1199
Practice Address - Fax:760-323-2769
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33567208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A27186Medicare UPIN
00A335671Medicare ID - Type Unspecified