Provider Demographics
NPI:1578618682
Name:WILLIAMS, ANGELINE H (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINE
Middle Name:H
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 LOUIS PASTEUR DR
Mailing Address - Street 2:910
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3415
Mailing Address - Country:US
Mailing Address - Phone:210-616-0640
Mailing Address - Fax:210-692-3561
Practice Address - Street 1:7711 LOUIS PASTEUR DR
Practice Address - Street 2:910
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3415
Practice Address - Country:US
Practice Address - Phone:210-616-0640
Practice Address - Fax:210-692-3561
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000SL765Medicaid
TX00SL76Medicare ID - Type UnspecifiedMEDICARE
TXP000SL765Medicaid