=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477116820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL LOGAN WILLIAMS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2019
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11161 SHADOW CREEK PKWY STE 217
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-7226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-657-1490
-----------------------------------------------------
Fax | 832-375-1247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11161 SHADOW CREEK PKWY STE 217
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-7226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-657-1490
-----------------------------------------------------
Fax | 832-375-1247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 692256
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 692256
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------