MEDICARE: BRIAN J WILLIAMS MD PC

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	:	1255502050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN J WILLIAMS MD PC

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	:	OWNER
Name	:	DR. BRIAN JEFFERY WILLIAMS
Credential	:	MD
Telephone Number	:	801-313-1010

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	09/16/2019

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