Provider Demographics
NPI:1093783011
Name:WILLIAMS, MICHAEL RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-0233
Mailing Address - Country:US
Mailing Address - Phone:830-997-9170
Mailing Address - Fax:830-997-9226
Practice Address - Street 1:415 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4636
Practice Address - Country:US
Practice Address - Phone:830-997-9170
Practice Address - Fax:830-997-9226
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGO288207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88770GOtherBCBS TX
TXA67812Medicare UPIN
TX85461JMedicare PIN