MEDICARE: TED MICHAEL WILLIAMS PA-C

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	363A00000X	Physician Assistant	PA04514	TX

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
2	75-2616977-042	OTHER	TX	TRICARE
3	836N57	OTHER	TX	BCBS
4	8N8739	OTHER	TX	BCBS OF TEXAS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497747273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED MICHAEL WILLIAMS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 S FLEISHEL AVE STE 4000
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2015
Country	:	US
Telephone Number	:	903-606-7000
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	02/25/2015

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