Provider Demographics
NPI:1013055128
Name:WILLIAMS, GRANT P (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:P
Last Name:WILLIAMS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7119 W SUNSET BLVD
Mailing Address - Street 2:#138
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4411
Mailing Address - Country:US
Mailing Address - Phone:310-271-8300
Mailing Address - Fax:310-271-8283
Practice Address - Street 1:250 N ROBERTSON BLVD
Practice Address - Street 2:#106
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1788
Practice Address - Country:US
Practice Address - Phone:310-271-8300
Practice Address - Fax:310-271-8283
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA54235208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG39706Medicare UPIN