MEDICARE: DR. JENNIFER WILLIAMS MD

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	207Q00000X	Family Medicine Physician	G55656	CA

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	:	1821050766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER WILLIAMS MD

Provider Business Mailing Address
First Line	:	652 PETALUMA AVE
Second Line	:	SUITE F
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4266
Country	:	US
Telephone Number	:	707-823-2334
Fax Number	:	707-823-3007

Provider Business Practice Location Address
First Line	:	652 PETALUMA AVE
Second Line	:	SUITE F
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4266
Country	:	US
Telephone Number	:	707-823-2334
Fax Number	:	707-823-3007

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	01/06/2012

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