Provider Demographics
NPI:1245203322
Name:WILLIAMS, LLOYD DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 COHEN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4429
Mailing Address - Country:US
Mailing Address - Phone:915-751-0000
Mailing Address - Fax:915-751-0464
Practice Address - Street 1:4659 COHEN AVE
Practice Address - Street 2:STE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4429
Practice Address - Country:US
Practice Address - Phone:915-751-0000
Practice Address - Fax:915-751-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0875213E00000X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018639702Medicaid
T16653Medicare UPIN
TX018639702Medicaid