MEDICARE: DR. BRADLEY RICHARD WILLIAMS M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518004340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY RICHARD WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	1334 29TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL MEDICAL CENTER DEPARTMENT OF PEDIATRICS
Second Line	:	34520 BOB WILSON DRIVE SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-2100
Country	:	US
Telephone Number	:	619-532-6474
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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