Provider Demographics
NPI:1033180252
Name:WILLIAMS, VERNON FLORINZEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:FLORINZEL
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 1:112 CANTER GAIT
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1458
Mailing Address - Country:US
Mailing Address - Phone:210-559-5959
Mailing Address - Fax:210-479-9605
Practice Address - Street 1:1905 HIGHWAY 97 E
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1504
Practice Address - Country:US
Practice Address - Phone:210-559-5959
Practice Address - Fax:210-479-9605
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9732207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139715022Medicaid
TX139715017Medicaid
TXE75371Medicare UPIN
TX0015BLMedicare ID - Type Unspecified