Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D10901 | OR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 189318 | OR |
NPI | 1457699142 |
---|---|
Provider Name | Dr. Bryan Christopher Williams |
First Address | Eugene, OR 97401-8181 |
Second Address | Eugene, OR 97401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2013 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188954 | MD LICENSE (01) | OR |
D10901 | DMD LICENSE (01) | OR |