Provider Demographics
NPI:1003897091
Name:WILLIAMS, VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N 19TH ST
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 N 19TH ST
Practice Address - Street 2:SUITE 4D
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2344
Practice Address - Country:US
Practice Address - Phone:325-676-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3189208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149854501Medicaid
TXG979192Medicare UPIN