Provider Demographics
NPI:1972577690
Name:WILLIAMS, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:145 VISTA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3607
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8350
Practice Address - Street 1:375 HUNTINGTON DR
Practice Address - Street 2:SUITE G
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2357
Practice Address - Country:US
Practice Address - Phone:626-441-4231
Practice Address - Fax:626-441-0282
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93503Medicare UPIN