Provider Demographics
NPI:1972819282
Name:WILLIAMS, GREGORY VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VERNON
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 1:3875 W BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0795
Mailing Address - Country:US
Mailing Address - Phone:559-646-7008
Mailing Address - Fax:
Practice Address - Street 1:3875 W BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0795
Practice Address - Country:US
Practice Address - Phone:559-646-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118641207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01507074OtherRAILROAD MEDICARE
CACA149535Medicare PIN