Provider Demographics
NPI:1821029505
Name:WILLIAMS, DAVID BRENT (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRENT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 ELM ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2909
Mailing Address - Country:US
Mailing Address - Phone:915-239-0003
Mailing Address - Fax:915-975-8172
Practice Address - Street 1:1533 N LEE TREVINO DR
Practice Address - Street 2:C1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5170
Practice Address - Country:US
Practice Address - Phone:915-433-0991
Practice Address - Fax:815-301-5599
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM320213ES0103X
TX1749213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180261304Medicaid
NMF8031Medicaid
NMNMB2035Medicare PIN
TXV09009Medicare UPIN
TX180261304Medicaid