Basic Information
| Provider Information | |||||||||
| NPI: | 1457561664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 VISCOUNT BLVD APT 147 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799255718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155495461 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1605 GEORGE DIETER DR STE 636 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799365692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152741617 | ||||||||
| FaxNumber: | 9152199022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 1725 | TX | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
No ID Information.