Provider Demographics
NPI:1023168721
Name:WILLIAMSON, TIMOTHY LEE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3119
Mailing Address - Country:US
Mailing Address - Phone:805-646-4386
Mailing Address - Fax:805-646-9188
Practice Address - Street 1:207 CHURCH RD
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3119
Practice Address - Country:US
Practice Address - Phone:805-646-4386
Practice Address - Fax:805-646-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32937208000000X, 208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G329370Medicaid
CA00G329370Medicaid
CAWG329370Medicare PIN
G32937Medicare PIN
CAG329370Medicare PIN
CAWG32937BMedicare PIN