Provider Demographics
NPI:1144244229
Name:WILLIAMS, MARGERINE WHITE
Entity Type:Individual
Prefix:MRS
First Name:MARGERINE
Middle Name:WHITE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4615
Mailing Address - Country:US
Mailing Address - Phone:713-440-0913
Mailing Address - Fax:713-440-0919
Practice Address - Street 1:3321 DIXIE DR.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021
Practice Address - Country:US
Practice Address - Phone:713-440-0913
Practice Address - Fax:713-440-0913
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030420171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030420Medicaid