MEDICARE: RICHARD 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	207R00000X	Internal Medicine Physician	G58242	CA

General Provider Information

NPI Number	:	1972577690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD WILLIAMS MD

Provider Business Mailing Address
First Line	:	145 VISTA AVE
Second Line	:	SUITE 104
City	:	PASADENA
State	:	CA
Zip	:	91107-3607
Country	:	US
Telephone Number	:	626-397-8335
Fax Number	:	626-397-8350

Provider Business Practice Location Address
First Line	:	375 HUNTINGTON DR
Second Line	:	SUITE G
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2357
Country	:	US
Telephone Number	:	626-441-4231
Fax Number	:	626-441-0282

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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