MEDICARE: DR. JONATHAN WAYNE WILLIAMS MD

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	207Q00000X	Family Medicine Physician	K8574	TX
2	207Q00000X	Family Medicine Physician	20416	OK

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	:	1588621874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN WAYNE WILLIAMS MD

Provider Business Mailing Address
First Line	:	1301 THIRD STREET
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-2245
Country	:	US
Telephone Number	:	940-767-5145
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S AVE D
Second Line	:
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-3564
Country	:	US
Telephone Number	:	940-569-1177
Fax Number	:	940-569-4969

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	10/20/2015

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