Healthcare Provider Details

I. General information

NPI: 1477116820
Provider Name (Legal Business Name): PAUL LOGAN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11161 SHADOW CREEK PKWY STE 217
PEARLAND TX
77584-7226
US

IV. Provider business mailing address

11161 SHADOW CREEK PKWY STE 217
PEARLAND TX
77584-7226
US

V. Phone/Fax

Practice location:
  • Phone: 281-657-1490
  • Fax: 832-375-1247
Mailing address:
  • Phone: 281-657-1490
  • Fax: 832-375-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number692256
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number692256
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: