Healthcare Provider Details

I. General information

NPI: 1578511846
Provider Name (Legal Business Name): JUSTIN BARRETT WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

3511 HILLDALE PT
SAN ANTONIO TX
78261-2353
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-0808
  • Fax: 210-916-2265
Mailing address:
  • Phone: 210-507-7069
  • Fax: 210-507-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35085855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: