Provider Demographics
NPI:1780833533
Name:WILLIAMS, CARL ROBERT JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:ROBERT
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CAMERON TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEHILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78063-6262
Mailing Address - Country:US
Mailing Address - Phone:830-751-2907
Mailing Address - Fax:
Practice Address - Street 1:315 CAMERON TRL
Practice Address - Street 2:
Practice Address - City:LAKEHILLS
Practice Address - State:TX
Practice Address - Zip Code:78063-6262
Practice Address - Country:US
Practice Address - Phone:210-232-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00167363AM0700X
AZPA 2328363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI24913710OtherCENTRAL CONTRACTOR REGISTRATION; TRADING PARTNER IDENTIFICATION NUMBER