Basic Information
Provider Information
NPI: 1760498364
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: RONALD
MiddleName: P
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 911230
Address2:  
City: DALLAS
State: TX
PostalCode: 753911230
CountryCode: US
TelephoneNumber: 9729978000
FaxNumber: 9722340813
Practice Location
Address1: 901 W 38TH ST STE 200
Address2:  
City: AUSTIN
State: TX
PostalCode: 787051165
CountryCode: US
TelephoneNumber: 5124214100
FaxNumber: 5124544575
Other Information
ProviderEnumerationDate: 08/01/2006
LastUpdateDate: 09/19/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XH6985TXY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
10292410105TX MEDICAID
10292410505TX MEDICAID
P0120201101TXRAILROAD MEDICAREOTHER
10292410201TXCIDCOTHER


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