Basic Information
| Provider Information | |||||||||
| NPI: | 1154350296 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | W SAM WILLIAMS JR MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1210 | ||||||||
| Address2: | |||||||||
| City: | GANADO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779621210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617713311 | ||||||||
| FaxNumber: | 3617713081 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 SOUTH 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | GANADO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779621210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617713311 | ||||||||
| FaxNumber: | 3617713081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | WILFORD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3617713311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.