Healthcare Provider Details

I. General information

NPI: 1346916822
Provider Name (Legal Business Name): JARED DAVID WILLIAMS BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 UNIVERSITY BLVD
TYLER TX
75799-6600
US

IV. Provider business mailing address

7438 TEXAS HIGHWAY 8 S
MAUD TX
75567-4589
US

V. Phone/Fax

Practice location:
  • Phone: 903-566-7000
  • Fax:
Mailing address:
  • Phone: 903-293-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: