Healthcare Provider Details

I. General information

NPI: 1154350296
Provider Name (Legal Business Name): W SAM WILLIAMS JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SOUTH 4TH STREET
GANADO TX
77962-1210
US

IV. Provider business mailing address

PO BOX 1210
GANADO TX
77962-1210
US

V. Phone/Fax

Practice location:
  • Phone: 361-771-3311
  • Fax: 361-771-3081
Mailing address:
  • Phone: 361-771-3311
  • Fax: 361-771-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILFORD S WILLIAMS JR.
Title or Position: OWNER
Credential: MD
Phone: 361-771-3311