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General NPI Number Information
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NPI Number | 1235478728
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Entity Type | Individual
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Provider Name | GREGORY A WILLIAMS IDC
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Gender | Male
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 03/16/2014
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Provider Practice Location Address
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Address Line | 2600 DODSON ST STE 3
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City | PORT HUENEME
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State | CA
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Zip | 93043-4432
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Country | US
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Telephone | 805-982-5945
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Fax |
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Provider Business Mailing Address
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Address Line | 1563 FLYNN RD APT 5106
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City | CAMARILLO
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State | CA
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Zip | 93012-5818
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Country | US
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Telephone | 360-929-0074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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