MEDICARE: DONALD J WILLIAMS MD A PROFESSIONAL CORPORATION

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	174400000X	Specialist

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

General Provider Information

NPI Number	:	1750380622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD J WILLIAMS MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1505 WILSON TER
Second Line	:	SUITE 155
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:	818-500-4087
Fax Number	:	818-500-4065

Provider Business Practice Location Address
First Line	:	1505 WILSON TER
Second Line	:	SUITE 155
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:	818-500-4087
Fax Number	:	818-500-4065

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD J WILLIAMS
Credential	:	M.D.
Telephone Number	:	818-500-4087

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/03/2008

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