Provider Demographics
NPI:1912921727
Name:WILLIAMS, EVERARD HORTON (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERARD
Middle Name:HORTON
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 1:65 N MADISON AVE
Mailing Address - Street 2:SUITE 709
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2035
Mailing Address - Country:US
Mailing Address - Phone:626-577-7792
Mailing Address - Fax:626-577-1060
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:SUITE 709
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2035
Practice Address - Country:US
Practice Address - Phone:626-577-7792
Practice Address - Fax:626-577-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16567207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G165670Medicaid
CA00G165670Medicaid
G16567Medicare ID - Type Unspecified