Provider Demographics
NPI:1598854432
Name:WILLIAMS, JEFFREY MARTIN (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARTIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O SCRIPPS MEDICAL FOUNDATION
Mailing Address - Street 2:10790 RANCHO BERNARDO RD, MAIL DROP 4S-205, DESK 2368
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-927-5527
Mailing Address - Fax:619-542-9239
Practice Address - Street 1:10862 CALLE VERDE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7340
Practice Address - Country:US
Practice Address - Phone:619-670-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA54254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D9311Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #