Provider Demographics
NPI:1962421586
Name:WILLIAMS, HOMER HERBERT JR (MD)
Entity type:Individual
Prefix:
First Name:HOMER
Middle Name:HERBERT
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 ASTER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8824
Mailing Address - Country:US
Mailing Address - Phone:337-480-8900
Mailing Address - Fax:337-480-8901
Practice Address - Street 1:2750 ASTER ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8824
Practice Address - Country:US
Practice Address - Phone:337-480-8900
Practice Address - Fax:337-480-8901
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09007R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1928534Medicaid
4E9397460Medicare PIN
LA5N946CN33Medicare ID - Type Unspecified
P00470494Medicare PIN
LAD73557Medicare UPIN