MEDICARE: DR. WESLEY WILLIAMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	21511	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205802105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 659506
Second Line	:	SECTION 4142
City	:	SAN ANTONIO
State	:	TX
Zip	:	78265-9506
Country	:	US
Telephone Number	:	405-869-7700
Fax Number	:	405-869-7724

Provider Business Practice Location Address
First Line	:	1636 MIDTOWN PL
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6347
Country	:	US
Telephone Number	:	405-869-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	01/08/2020

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