Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | R9892 | TX |
Y | 207Q00000X | Family Doctor | R9892 | TX |
NPI | 1548623044 |
---|---|
Provider Name | Dr. Nathan Williams |
First Address | Fort Worth, TX 76107-2553 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 25/01/2022 |