Provider Demographics
NPI:1689740003
Name:WILLIAMS, DWAYNE ONEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:ONEAL
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 1:17510 W GRAND PKWY S
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2645
Mailing Address - Country:US
Mailing Address - Phone:281-238-3100
Mailing Address - Fax:281-238-3101
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:SUITE 180
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-238-3100
Practice Address - Fax:281-238-3101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131699407Medicaid
TX760343916OtherTAX ID NUMBER
TX00818MMedicare ID - Type Unspecified
TXE30407Medicare UPIN