Healthcare Provider Details

I. General information

NPI: 1336145606
Provider Name (Legal Business Name): BARON JAMES WILLIAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 CHURCH ST
ZACHARY LA
70791-2710
US

IV. Provider business mailing address

2421 CHURCH ST
ZACHARY LA
70791-2710
US

V. Phone/Fax

Practice location:
  • Phone: 225-654-1061
  • Fax: 225-654-0791
Mailing address:
  • Phone: 225-654-1061
  • Fax: 225-654-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number021383
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: