Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1536 | SC |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | G0289 | TX |
N | 207Q00000X | Family Doctor | 1536 | SC |
NPI | 1407829864 |
---|---|
Provider Name | Stuart F Williams |
First Address | Southlake, TX 76092-7846 |
Second Address | Southlake, TX 76092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 25/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015361 | (05) | SC |
080170217 | RAILROAD MEDICARE PIN (01) | TX |
118515904 | (05) | TX |
83036G | BCBS (01) | TX |
E75138 | (02) | TX |