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General NPI Number Information
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NPI Number | 1164974598
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Entity Type | Individual
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Provider Name | THOMAS EDGAR MCWILLIAMS D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 3247FDR250
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City | LA JARA
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State | CO
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Zip | 81140
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Country | US
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Telephone | 623-332-7774
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1959
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City | ALAMOSA
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State | CO
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Zip | 81101-1959
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Country | US
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Telephone | 623-332-7774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2095
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2412
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License Number State | AZ
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