Provider Demographics
NPI:1992554653
Name:WILLIAMS, ROBBIE EUGENE JR
Entity type:Individual
Prefix:
First Name:ROBBIE
Middle Name:EUGENE
Last Name:WILLIAMS
Suffix:JR
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 1:301 BANDERA DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-4802
Mailing Address - Country:US
Mailing Address - Phone:903-730-0566
Mailing Address - Fax:469-886-1889
Practice Address - Street 1:301 BANDERA DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-4802
Practice Address - Country:US
Practice Address - Phone:903-730-0566
Practice Address - Fax:469-886-1889
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker