MEDICARE: MR. HAYDEN DELBERT WILLIAMS III

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	247100000X	Radiologic Technologist	88150	CA

General Provider Information

NPI Number	:	1780958181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAYDEN DELBERT WILLIAMS III

Provider Business Mailing Address
First Line	:	PMB 517 4101 DUBLIN BLVD STE F
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568
Country	:	US
Telephone Number	:	925-895-1714
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 DUBLIN BLVD
Second Line	:	STE F PMB 517
City	:	DUBLIN
State	:	CA
Zip	:	94568-4592
Country	:	US
Telephone Number	:	925-895-1714
Fax Number	:

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

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	03/02/2012

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