Provider Demographics
NPI:1699795088
Name:WILLIAMS, GREGORY GRANT (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GRANT
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 1:1500 HAGGIN OAKS BLVD
Mailing Address - Street 2:202
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1333
Mailing Address - Country:US
Mailing Address - Phone:661-654-8346
Mailing Address - Fax:661-654-8337
Practice Address - Street 1:1500 HAGGIN OAKS BLVD
Practice Address - Street 2:202
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1333
Practice Address - Country:US
Practice Address - Phone:661-654-8346
Practice Address - Fax:661-654-8337
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053508176OtherTYPE 2 NPI
CAZZZ25253ZMedicare PIN