Healthcare Provider Details

I. General information

NPI: 1982699302
Provider Name (Legal Business Name): BRADFORD JAY WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5210 BOX 230
APO AE
09461
GB

IV. Provider business mailing address

PSC 37 BOX 597
APO AE
09459
GB

V. Phone/Fax

Practice location:
  • Phone: 01144163852
  • Fax:
Mailing address:
  • Phone: 01144163854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ2413
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: