Provider Demographics
NPI:1144220369
Name:WILLIAMS, JOHN P (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1712 S MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4400
Mailing Address - Country:US
Mailing Address - Phone:707-459-5585
Mailing Address - Fax:707-459-3548
Practice Address - Street 1:1712 S MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4400
Practice Address - Country:US
Practice Address - Phone:707-459-5585
Practice Address - Fax:707-459-3548
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX60271Medicaid
CA020A60270OtherBLUE SHIELD PROVIDER #
CA110228689OtherRAILROAD MEDICARE
CA20A6027OtherBLUE CROSS PROVIDER #
CA020A60271Medicare PIN
CAF22716Medicare UPIN