Provider Demographics
NPI:1912132689
Name:EVERARD H. WILLIAMS, M.D., INC.
Entity type:Organization
Organization Name:EVERARD H. WILLIAMS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERARD
Authorized Official - Middle Name:HORTON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:626-577-7792
Mailing Address - Street 1:65 N MADISON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2035
Mailing Address - Country:US
Mailing Address - Phone:626-577-7792
Mailing Address - Fax:626-577-1060
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2035
Practice Address - Country:US
Practice Address - Phone:626-577-7792
Practice Address - Fax:626-577-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16567207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G165670Medicaid
CAA90437Medicare UPIN