Healthcare Provider Details

I. General information

NPI: 1245203322
Provider Name (Legal Business Name): LLOYD DAVID WILLIAMS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4659 COHEN AVE STE A
EL PASO TX
79924-4429
US

IV. Provider business mailing address

4659 COHEN AVE STE A
EL PASO TX
79924-4429
US

V. Phone/Fax

Practice location:
  • Phone: 915-751-0000
  • Fax: 915-751-0464
Mailing address:
  • Phone: 915-751-0000
  • Fax: 915-751-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0875
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number0875
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0875
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: