Healthcare Provider Details

I. General information

NPI: 1508821273
Provider Name (Legal Business Name): LAWRENCE JAMES WILLIAMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MEDICAL CENTER PLAZA SUITE 23
WINDSOR CA
95492-7817
US

IV. Provider business mailing address

PO BOX 1820
WINDSOR CA
95492-1820
US

V. Phone/Fax

Practice location:
  • Phone: 707-837-0170
  • Fax: 707-837-0177
Mailing address:
  • Phone: 707-837-0170
  • Fax: 707-837-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA73495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: