Provider Demographics
NPI:1457699142
Name:WILLIAMS, BRYAN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CHRISTOPHER
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 1:330 S GARDEN WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8181
Mailing Address - Country:US
Mailing Address - Phone:541-686-9750
Mailing Address - Fax:402-559-3499
Practice Address - Street 1:330 S GARDEN WAY STE 140
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-686-9750
Practice Address - Fax:541-485-5034
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR189318204E00000X
ORD109011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR188954OtherMD LICENSE
ORD10901OtherDMD LICENSE