Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | L3189 | TX |
Y | 208600000X | Surgeon | L3189 | TX |
NPI | 1003897091 |
---|---|
Provider Name | Dr. Vernon Williams |
First Address | Abilene, TX 79601-2344 |
Second Address | Abilene, TX 79601-2344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149854501 | (05) | TX |
G979192 | (02) | TX |