Provider Demographics
NPI:1619359304
Name:WILLIAMS, JEREMY SHANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SHANNON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:SAMMC, MCHE-MDX, INTERNAL MEDICINE RESIDENCY
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-8176
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:SAMMC, MCHE-MDX, INTERNAL MEDICINE RESIDENCY
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-8176
Practice Address - Fax:210-292-7868
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2017-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101262111208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program