MEDICARE: DEVON WILLIAMS PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	03285	TX

General Provider Information

NPI Number	:	1407886062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON WILLIAMS PAC

Provider Business Mailing Address
First Line	:	3617 SLICKROCK DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-7777
Country	:	US
Telephone Number	:	214-450-5578
Fax Number	:

Provider Business Practice Location Address
First Line	:	3617 SLICKROCK DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-7777
Country	:	US
Telephone Number	:	214-450-5578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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Directions to “ DEVON WILLIAMS PAC” Practice Location

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