Healthcare Provider Details

I. General information

NPI: 1912132689
Provider Name (Legal Business Name): EVERARD H. WILLIAMS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2009
Last Update Date: 05/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MADISON AVE SUITE 201
PASADENA CA
91101-2035
US

IV. Provider business mailing address

65 N MADISON AVE SUITE 201
PASADENA CA
91101-2035
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-7792
  • Fax: 626-577-1060
Mailing address:
  • Phone: 626-577-7792
  • Fax: 626-577-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG16567
License Number StateCA

VIII. Authorized Official

Name: DR. EVERARD HORTON WILLIAMS SR.
Title or Position: OWNER/PRES.
Credential: M.D.
Phone: 626-577-7792