Basic Information
Provider Information
NPI: 1760526743
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: CHARLES
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 25033
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927995033
CountryCode: US
TelephoneNumber: 7143471010
FaxNumber: 7143471082
Practice Location
Address1: 681 S PARKER ST STE 150
Address2:  
City: ORANGE
State: CA
PostalCode: 92868
CountryCode: US
TelephoneNumber: 7147440900
FaxNumber: 7147449232
Other Information
ProviderEnumerationDate: 02/16/2007
LastUpdateDate: 08/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LP2900XG51191CAN Allopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
207L00000XG51191CAY Allopathic & Osteopathic PhysiciansAnesthesiology 
174400000XNV10899NVN Other Service ProvidersSpecialist 

No ID Information.


Home