Provider Demographics
NPI:1194797258
Name:WILLIAMS, FREDERICK D (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1506 CENTINELA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-1144
Mailing Address - Country:US
Mailing Address - Phone:310-419-5075
Mailing Address - Fax:310-419-0520
Practice Address - Street 1:6722 ABBOTTSWOOD DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3018
Practice Address - Country:US
Practice Address - Phone:310-422-9458
Practice Address - Fax:310-541-8891
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41755208D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G417550Medicaid
CAG41755Medicare ID - Type Unspecified
CA00G417550Medicaid