Healthcare Provider Details

I. General information

NPI: 1114089562
Provider Name (Legal Business Name): MICHAEL ERLE WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVENUE, BLDG. 340, SUITE 401
VENTURA CA
93003
US

IV. Provider business mailing address

280 MISSION DR
CAMARILLO CA
93010-2024
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6201
  • Fax: 805-641-4416
Mailing address:
  • Phone: 805-482-9916
  • Fax: 805-713-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG12205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: