Provider Demographics
NPI:1033357603
Name:PHILLIP E. WILLIAMS, JR, MD PA
Entity Type:Organization
Organization Name:PHILLIP E. WILLIAMS, JR, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EARLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-3333
Mailing Address - Street 1:7515 GREENVILLE AVE
Mailing Address - Street 2:STE 1000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3852
Mailing Address - Country:US
Mailing Address - Phone:214-369-3333
Mailing Address - Fax:214-369-9933
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:STE 1000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3852
Practice Address - Country:US
Practice Address - Phone:214-369-3333
Practice Address - Fax:214-369-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDD2172207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099333901Medicaid
TX0A3954Medicare PIN
TX00L679Medicare PIN
TXC23564Medicare UPIN