Provider Demographics
NPI:1649099250
Name:WILLIAMSON, PATRICK
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:BOULEVARD
Mailing Address - State:CA
Mailing Address - Zip Code:91905-0325
Mailing Address - Country:US
Mailing Address - Phone:619-840-8889
Mailing Address - Fax:
Practice Address - Street 1:39177 OLD HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:BOULEVARD
Practice Address - State:CA
Practice Address - Zip Code:91905-9684
Practice Address - Country:US
Practice Address - Phone:619-840-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty