Healthcare Provider Details

I. General information

NPI: 1427068105
Provider Name (Legal Business Name): JANNE BOWEN-WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 CENTER BLVD BOX 400
FAIRFAX CA
94930-1738
US

IV. Provider business mailing address

PO BOX 400
FAIRFAX CA
94978-0400
US

V. Phone/Fax

Practice location:
  • Phone: 415-455-9229
  • Fax: 415-456-2427
Mailing address:
  • Phone: 415-455-9229
  • Fax: 415-456-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG46586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: