Provider Demographics
NPI:1588621874
Name:WILLIAMS, JONATHAN WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WAYNE
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 1:1301 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-2245
Mailing Address - Country:US
Mailing Address - Phone:940-767-5145
Mailing Address - Fax:
Practice Address - Street 1:312 S AVE D
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3564
Practice Address - Country:US
Practice Address - Phone:940-569-1177
Practice Address - Fax:940-569-4969
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8574207Q00000X
OK20416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110740105Medicaid
TX110740105Medicaid
TX8B1355Medicare PIN
TX00755FMedicare PIN