Provider Demographics
NPI:1629392378
Name:WILLIAMS, WAYLON DALE (CRNA)
Entity Type:Individual
Prefix:
First Name:WAYLON
Middle Name:DALE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:1500 CITYWEST BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2300
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684097367500000X
TXAP118860367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211930702Medicaid
TX211930708Medicaid
TXP01938601OtherMEDICARE RAIL ROAD
TX75-1976930-005OtherTRICARE
TX750818167015OtherTRICARE
TX8152UAOtherBCBS
TX8299UMOtherBCBS
TXP00825457OtherRAILROAD MEDICARE
TX211930703Medicaid
TX2119307Medicaid
TX290377YN3XOtherMEDICARE
TX8328UEOtherBCBS
TX211930701Medicaid
TX8GX999OtherBCBS
TXP01246283OtherRAIL ROAD
TX750818167015OtherTRICARE
290377YSE3Medicare PIN