Healthcare Provider Details

I. General information

NPI: 1265488548
Provider Name (Legal Business Name): MR. R LEE WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date: 10/11/2016
Reactivation Date: 10/31/2016

III. Provider practice location address

2544 UNION RD
SAINT LOUIS MO
63125-3449
US

IV. Provider business mailing address

9340 CINCHONA TRL
GARDEN RIDGE TX
78266-2323
US

V. Phone/Fax

Practice location:
  • Phone: 888-223-8559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF7307
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberF7307
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: