Provider Demographics
NPI:1528259900
Name:BENJAMIN J. WILLIAMS MD, PHD, PA
Entity type:Organization
Organization Name:BENJAMIN J. WILLIAMS MD, PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, PA
Authorized Official - Phone:806-722-3030
Mailing Address - Street 1:4642 N LOOP 289 STE 203
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-2424
Mailing Address - Country:US
Mailing Address - Phone:806-722-3030
Mailing Address - Fax:806-722-3035
Practice Address - Street 1:4642 N LOOP 289 STE 203
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2424
Practice Address - Country:US
Practice Address - Phone:806-722-3030
Practice Address - Fax:806-722-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00969XMedicare PIN