Provider Demographics
NPI:1942372909
Name:WILLIAMS, JON H (DPM)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:H
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2486 N PONDEROSA DR
Mailing Address - Street 2:SUITE D-100
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2376
Mailing Address - Country:US
Mailing Address - Phone:805-987-3401
Mailing Address - Fax:805-987-3403
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:SUITE D-100
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-987-3401
Practice Address - Fax:805-987-3403
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE2307213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11273Medicare UPIN