Healthcare Provider Details

I. General information

NPI: 1255369450
Provider Name (Legal Business Name): FREDDIE ALVIN WILLIAMS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 WHITTIER BLVD
LA CA
90023-3526
US

IV. Provider business mailing address

PO BOX 1229
SO PASADENA CA
91031-1229
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-5514
  • Fax: 323-296-8613
Mailing address:
  • Phone: 213-842-4354
  • Fax: 323-296-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA53688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA53688
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA53688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: