MEDICARE: DR. FREDERICK D WILLIAMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G41755	CA
2	207W00000X	Ophthalmology Physician	G41755	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194797258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK D WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	1506 CENTINELA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-1144
Country	:	US
Telephone Number	:	310-419-5075
Fax Number	:	310-419-0520

Provider Business Practice Location Address
First Line	:	6722 ABBOTTSWOOD DR
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-3018
Country	:	US
Telephone Number	:	310-422-9458
Fax Number	:	310-541-8891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	05/12/2020

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