Basic Information
| Provider Information | |||||||||
| NPI: | 1073823522 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KELCEY L. WILLIAMS, MD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2541 S IH 35 # 200-242 | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786647360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123635779 | ||||||||
| FaxNumber: | 5122924458 | ||||||||
| Practice Location | |||||||||
| Address1: | 2541 S IH 35 # 200-242 | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786647360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123635779 | ||||||||
| FaxNumber: | 5122924458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 05/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | KELCEY | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/RENDERING PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 5123635779 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | L7926 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.