Individual provider Active NPI

Jordan Williams, MD

  • Surgery Physician
  • Travis Afb, CA
National Provider Identifier
1639707334
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
202930 Issued in CA
Practice address
60 MDG/SGCS
101 Bodin Circle
Travis Afb, CA 94535-1809
Phone
(707) 423-5216
NPI assigned
Mar 29, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 202930 CA Primary

Addresses

Primary practice location

60 MDG/SGCS
101 Bodin Circle
Travis Afb, CA 94535-1809

Mailing address

60 MDG/SGCS
101 Bodin Circle
Travis Afb, CA 94535-1809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Uniformed Services Uhs Fe Hebert School of Med, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5820 Owens Dr BLDG E 2ND Floor
Pleasanton, CA 94588-3900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
202930CAMDSurgery Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1639707334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MDG/SGCS",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MDG/SGCS",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-29",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "202930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Travis Afb, CA

Sources for this page

Verify at the official NPI Registry.