Provider Demographics
NPI:1376545293
Name:WILLIAMS, TERRY E (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:EARL
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4127
Mailing Address - Country:US
Mailing Address - Phone:281-332-8571
Mailing Address - Fax:281-332-8307
Practice Address - Street 1:12 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4127
Practice Address - Country:US
Practice Address - Phone:281-332-8571
Practice Address - Fax:281-332-8307
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2391207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX070000903OtherMEDICARE RAILROAD
TX81342XOtherBCBS OF TEXAS
TX82690NMedicare PIN
TX81342XOtherBCBS OF TEXAS