Provider Demographics
NPI:1316252984
Name:WILLIAMS, DAVID STUART
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STUART
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9693
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-2693
Mailing Address - Country:US
Mailing Address - Phone:903-521-2221
Mailing Address - Fax:
Practice Address - Street 1:1401 WOODLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8527
Practice Address - Country:US
Practice Address - Phone:903-521-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12218146L00000X
TX694863163WE0003X
5001-0701-0049-881183700000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No183700000XPharmacy Service ProvidersPharmacy Technician