Provider Demographics
NPI:1578511846
Name:WILLIAMS, JUSTIN BARRETT (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BARRETT
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 1:3511 HILLDALE PT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2353
Mailing Address - Country:US
Mailing Address - Phone:210-507-7069
Mailing Address - Fax:210-507-7069
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-0808
Practice Address - Fax:210-916-2265
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085855207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2570472Medicaid
WI4159701Medicare UPIN
I30983Medicare UPIN