Provider Demographics
NPI:1922070127
Name:WILLIAMS, JANE D (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 994032
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4032
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:1225 CENTRAL AVE
Practice Address - Street 2:STE 12
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4390
Practice Address - Country:US
Practice Address - Phone:707-840-0758
Practice Address - Fax:707-840-9141
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG68304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G683040Medicaid
CAG15387Medicare UPIN
CA00G683040Medicaid