Provider Demographics
NPI:1013055128
Name:WILLIAMS, GRANT P (MD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2275 HUNTINGTON DR STE 371
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2640
Mailing Address - Country:US
Mailing Address - Phone:877-331-3878
Mailing Address - Fax:888-578-6188
Practice Address - Street 1:706 W BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1032
Practice Address - Country:US
Practice Address - Phone:877-331-3878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54235208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG39706Medicare UPIN