Healthcare Provider Details

I. General information

NPI: 1790206092
Provider Name (Legal Business Name): JOHN WILLIAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/24/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

PO BOX 532
WILDER VT
05088-0532
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone: 603-686-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD467935
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA203387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: