Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | G84209 | CA |
Y | 2084N0400X | Neurologist | G84209 | CA |
NPI | 1437113313 |
---|---|
Provider Name | Vernon Brian Williams |
First Address | Los Angeles, CA 90045-1543 |
Second Address | Los Angeles, CA 90045-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G74563 | (02) | CA |