Healthcare Provider Details

I. General information

NPI: 1194797258
Provider Name (Legal Business Name): FREDERICK D WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 ABBOTTSWOOD DR
RANCHO PALOS VERDES CA
90275-3018
US

IV. Provider business mailing address

1506 CENTINELA AVE
INGLEWOOD CA
90302-1144
US

V. Phone/Fax

Practice location:
  • Phone: 310-422-9458
  • Fax: 310-541-8891
Mailing address:
  • Phone: 310-419-5075
  • Fax: 310-419-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG41755
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG41755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: