Healthcare Provider Details

I. General information

NPI: 1588774368
Provider Name (Legal Business Name): NEVILLE W. N WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST SUITE210
PASADENA CA
91105-3045
US

IV. Provider business mailing address

10 CONGRESS ST SUITE210
PASADENA CA
91105-3027
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-8640
  • Fax: 626-577-6502
Mailing address:
  • Phone: 626-577-8640
  • Fax: 626-577-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA34071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: