Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 21580 | TX |
NPI | 1568408730 |
---|---|
Provider Name | Dale Wayne Williams |
First Address | Austin, TX 78757-6953 |
Second Address | Austin, TX 78757-6802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 29/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P000T97A2 | (05) | TX |
S17353 | (02) |