Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD24895 | OR |
NPI | 1033116454 |
---|---|
Provider Name | Dr. Fred C Williams JR. |
First Address | Hillsboro, OR 97124-4904 |
Second Address | Hillsboro, OR 97124-4904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 21/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
297679 | (05) | OR |
E85970 | (02) | OR |