MEDICARE: DR. LEO JOSEPH WILLIAMS JR.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	C6553	TX

General Provider Information

NPI Number	:	1770992364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO JOSEPH WILLIAMS JR.

Provider Business Mailing Address
First Line	:	11726 LEGEND MANOR DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-3076
Country	:	US
Telephone Number	:	291-759-7889
Fax Number	:	281-759-7889

Provider Business Practice Location Address
First Line	:	11726 LEGEND MANOR DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-3076
Country	:	US
Telephone Number	:	291-759-7889
Fax Number	:	281-759-7889

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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