Healthcare Provider Details

I. General information

NPI: 1194990077
Provider Name (Legal Business Name): MITCHELL N WILLIAMS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 12TH AVE STE 104
FORT WORTH TX
76104-3928
US

IV. Provider business mailing address

1001 12TH AVE STE 104
FORT WORTH TX
76104-3928
US

V. Phone/Fax

Practice location:
  • Phone: 682-708-3300
  • Fax: 682-708-3299
Mailing address:
  • Phone: 682-708-3300
  • Fax: 682-708-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1852
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number679
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: