Provider Demographics
NPI:1851325823
Name:MCWILLIAMS, JEREMY KIRK (DO)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:KIRK
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19782 HIGHWAY 105 WEST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356
Mailing Address - Country:US
Mailing Address - Phone:936-582-0220
Mailing Address - Fax:936-582-0222
Practice Address - Street 1:19782 HIGHWAY 105 WEST
Practice Address - Street 2:SUITE 111
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356
Practice Address - Country:US
Practice Address - Phone:936-582-0220
Practice Address - Fax:936-582-0222
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMO818207Q00000X
TXM0818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175774201Medicaid
TX8D8210Medicare ID - Type Unspecified
TX175774201Medicaid