1598854432 NPI number — JEFFREY MARTIN WILLIAMS PA-C

Table of content: JEFFREY MARTIN WILLIAMS PA-C (NPI 1598854432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598854432 NPI number — JEFFREY MARTIN WILLIAMS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JEFFREY
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598854432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C/O SCRIPPS MEDICAL FOUNDATION
Provider Second Line Business Mailing Address:
10790 RANCHO BERNARDO RD, MAIL DROP 4S-205, DESK 2368
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92127-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-927-5527
Provider Business Mailing Address Fax Number:
619-542-9239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10862 CALLE VERDE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-7340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA54254 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com