Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 43257 | TN |
N | 2084N0402X | Child Neurologist | E-6153 | AR |
Y | 2084N0402X | Child Neurologist | ME146564 | FL |
N | 2084N0402X | Child Neurologist | Q1773 | TX |
NPI | 1326195298 |
---|---|
Provider Name | Randy Williamson |
First Address | Harlingen, TX 78550-8736 |
Second Address | Pensacola, FL 32504-8785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 28/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2088965-04 | (05) | TX |
8HQ341 | BCBS (01) | TX |