MEDICARE: JUSTIN BARRETT WILLIAMS M.D.

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	207P00000X	Emergency Medicine Physician	35085855	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578511846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN BARRETT WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	3511 HILLDALE PT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2353
Country	:	US
Telephone Number	:	210-507-7069
Fax Number	:	210-507-7069

Provider Business Practice Location Address
First Line	:	3851 ROGER BROOKE DR
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4501
Country	:	US
Telephone Number	:	210-916-0808
Fax Number	:	210-916-2265

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/08/2007

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