=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881898922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAMS FAMILY PRACTICE, P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 03/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 E CROCKETT ST SUITE A
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77327-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-592-2656
-----------------------------------------------------
Fax | 281-592-9723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 E CROCKETT ST STE A
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77327-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-592-2656
-----------------------------------------------------
Fax | 281-592-9723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | BALMORE WILLOUGHBY WILLIAMS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-592-2656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L2751
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------