Provider Demographics
NPI:1700076924
Name:WILLIAMS, REX DALE (MD)
Entity Type:Individual
Prefix:MR
First Name:REX
Middle Name:DALE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5405
Mailing Address - Country:US
Mailing Address - Phone:510-752-6418
Mailing Address - Fax:
Practice Address - Street 1:280 WEST MACARTHUR BLVD
Practice Address - Street 2:SURGERY CLINIC ROOM 109
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5693
Practice Address - Country:US
Practice Address - Phone:510-752-6418
Practice Address - Fax:510-752-7839
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28180208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17941Medicare UPIN