Provider Demographics
NPI:1346260049
Name:WILLIAMS, TERRY RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:RAYMOND
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:#1340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-522-1944
Mailing Address - Fax:713-522-6575
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:#1340
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-522-1944
Practice Address - Fax:713-522-6575
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6951208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34006257OtherRAILROAD MEDICARE
TX835512OtherBLUE CROSS BLUE SHIELD
TX042115801Medicaid
TX835512OtherBLUE CROSS BLUE SHIELD
TXD69260Medicare UPIN