Provider Demographics
NPI:1528164753
Name:WILLIAMS, JEFFREY KENT (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENT
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 1:1901 FOURTH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2381
Mailing Address - Country:US
Mailing Address - Phone:619-236-1199
Mailing Address - Fax:619-236-0911
Practice Address - Street 1:1901 FOURTH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2381
Practice Address - Country:US
Practice Address - Phone:619-236-1199
Practice Address - Fax:619-236-0911
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59161207RC0000X, 246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE93652Medicare UPIN
CAG59161Medicare PIN