Provider Demographics
NPI:1336170869
Name:WILLIAMS, MARK DWIGHT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DWIGHT
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:NMCSD, ATTN: MEDICAL STAFF SERVICES
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-532-6400
Mailing Address - Fax:
Practice Address - Street 1:34800 WILSON DR.
Practice Address - Street 2:NMCSD, ATTN: MEDICAL STAFF, SERVICES
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134
Practice Address - Country:US
Practice Address - Phone:619-532-6460
Practice Address - Fax:619-532-6299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-02-24
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Provider Licenses
StateLicense IDTaxonomies
CAA80386208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice