Healthcare Provider Details

I. General information

NPI: 1457345423
Provider Name (Legal Business Name): EDMUND P WILLIAMS IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TED WILLIAMS MD

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7122 STONEWALL HL
SAN ANTONIO TX
78256-1926
US

IV. Provider business mailing address

7122 STONEWALL HL
SAN ANTONIO TX
78256-1926
US

V. Phone/Fax

Practice location:
  • Phone: 210-404-9696
  • Fax: 210-404-9466
Mailing address:
  • Phone: 210-404-9696
  • Fax: 210-404-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG3912
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG3912
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG3912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: