MEDICARE: GABRIEL WILLIAMS

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1659797595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL WILLIAMS

Provider Business Mailing Address
First Line	:	1609 ORCHID ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7779
Country	:	US
Telephone Number	:	337-438-1645
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 ORCHID ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7779
Country	:	US
Telephone Number	:	337-438-1645
Fax Number	:

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

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	03/17/2014

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Directions to “ GABRIEL WILLIAMS ” Practice Location

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