Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 706477 | TX |
NPI | 1003219767 |
---|---|
Provider Name | Eric Lee Williams |
First Address | Wichita Falls, TX 76308-2519 |
Second Address | Wichita Falls, TX 76308-2519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 08/10/2014 |