Provider Demographics
NPI:1043304843
Name:WILLIAMS, JANICE MAXINE (PA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MAXINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2525 HOLLY HALL ST
Mailing Address - Street 2:ROOM 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4124
Mailing Address - Country:US
Mailing Address - Phone:713-566-6711
Mailing Address - Fax:713-440-1200
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:ROOM 211
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-566-6711
Practice Address - Fax:713-440-1200
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P81880Medicare UPIN
8A4117Medicare ID - Type Unspecified