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General NPI Number Information
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NPI Number | 1558311969
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Entity Type | Organization
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Legal Business Name | WILLIAMS MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 111 N TAYLOR AVE SUITE A
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City | KIRKWOOD
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State | MO
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Zip | 63122-4358
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Country | US
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Telephone | 314-822-9997
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Fax | 314-822-9994
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Provider Business Mailing Address
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Address Line | PO BOX 1039
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City | FULLERTON
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State | CA
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Zip | 92836-1039
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Country | US
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Telephone | 415-595-6734
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Fax | 714-526-3110
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Authorized Official
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Title or Position | SECRETARY-TREASURER
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Name | MR. JEFFREY MARCUS WILMOTH
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Credential |
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Telephone | 415-595-6734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2657039-0
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License Number State | FL
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