Provider Demographics
NPI:1689650202
Name:WILLIAMS, RONALD E (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 SABLE CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2219
Mailing Address - Country:US
Mailing Address - Phone:210-861-4107
Mailing Address - Fax:210-568-4641
Practice Address - Street 1:3326 SABLE CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2219
Practice Address - Country:US
Practice Address - Phone:210-861-4107
Practice Address - Fax:210-568-4641
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR7006207Q00000X
TXN7979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240648113Medicaid
008012629Medicare ID - Type Unspecified
D41568Medicare UPIN