Individual
BRIAN JEFFERY WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
602 FORT UNION BLVD, 2ND FLOOR, MIDVALE, UT 84047-2216
(801) 313-1010
(801) 747-2116
Mailing address
602 FORT UNION BLVD, 2ND FLOOR, MIDVALE, UT 84047-2216
(801) 313-1010
(801) 747-2116
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5322538-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235162199
—
UT
01
—
D5439
MEDICAID LICENSE NUMBER
UT
Enumeration date
07/07/2006
Last updated
12/09/2009
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