Healthcare Provider Details

I. General information

NPI: 1457699142
Provider Name (Legal Business Name): BRYAN CHRISTOPHER WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S GARDEN WAY STE 140
EUGENE OR
97401
US

IV. Provider business mailing address

330 S GARDEN WAY STE 140
EUGENE OR
97401-8181
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-9750
  • Fax: 541-485-5034
Mailing address:
  • Phone: 541-686-9750
  • Fax: 402-559-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number189318
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD10901
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: