Healthcare Provider Details

I. General information

NPI: 1538493705
Provider Name (Legal Business Name): ANTHONY D WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 COFFEE RD STE 1
MODESTO CA
95355-4240
US

IV. Provider business mailing address

937 COFFEE RD STE 1
MODESTO CA
95355-4240
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-7221
  • Fax: 209-529-7221
Mailing address:
  • Phone: 209-529-7221
  • Fax: 209-529-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: