Healthcare Provider Details

I. General information

NPI: 1295790319
Provider Name (Legal Business Name): BYRON WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SOUTH CHEVY CHASE DRIVE #105
GLENDALE CA
91205
US

IV. Provider business mailing address

801 SOUTH CHEVY CHASE DRIVE #105
GLENDALE CA
91205
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-5299
  • Fax: 818-637-7607
Mailing address:
  • Phone: 818-242-5299
  • Fax: 818-637-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG76616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: