MEDICARE: BRIAN JEFFERY WILLIAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	5322538-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235162199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JEFFERY WILLIAMS MD

Provider Business Mailing Address
First Line	:	602 FORT UNION BLVD
Second Line	:	2ND FLOOR
City	:	MIDVALE
State	:	UT
Zip	:	84047-2216
Country	:	US
Telephone Number	:	801-313-1010
Fax Number	:	801-747-2116

Provider Business Practice Location Address
First Line	:	602 FORT UNION BLVD
Second Line	:	2ND FLOOR
City	:	MIDVALE
State	:	UT
Zip	:	84047-2216
Country	:	US
Telephone Number	:	801-313-1010
Fax Number	:	801-747-2116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/09/2009

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