Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME124635 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MT215089 | PA |
NPI | 1629336086 |
---|---|
Provider Name | Dr. Brendan Alexander Williams |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 30/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021286800 | (05) | FL |
JA199Z | MEDICARE PTAN (01) | FL |