Provider Demographics
NPI:1699901645
Name:WILLIAMS, TERESA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9189
Mailing Address - Country:US
Mailing Address - Phone:866-713-3776
Mailing Address - Fax:866-713-3776
Practice Address - Street 1:800 WILCREST DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-6301
Practice Address - Country:US
Practice Address - Phone:866-713-3776
Practice Address - Fax:866-713-3776
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9984208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB143908Medicare UPIN