Provider Demographics
NPI:1407829864
Name:WILLIAMS, STUART F (DO)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:F
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MIRON DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7846
Mailing Address - Country:US
Mailing Address - Phone:817-416-0970
Mailing Address - Fax:817-498-0898
Practice Address - Street 1:230 MIRON DR STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-416-0970
Practice Address - Fax:817-498-0898
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1536204D00000X, 207Q00000X
TXG0289204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC015361Medicaid
TX83036GOtherBCBS
TX080170217OtherRAILROAD MEDICARE PIN
TX118515904Medicaid
TX87824JMedicare PIN
SC015361Medicaid
SCAA97363365Medicare PIN