Provider Demographics
NPI:1891766044
Name:WILLIAMS, KENNETH EGBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EGBERT
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:PO BOX 650802
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0802
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:STE 1000W
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4911
Practice Address - Country:US
Practice Address - Phone:972-715-5007
Practice Address - Fax:972-715-5682
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8420207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135314614Medicaid
TX135314613Medicaid
TX8CD667OtherBCBS
TX135314604Medicaid
TX8CN978OtherBCBS
TXBCBSOther8CG951
TX135314615Medicaid
TX135314614Medicaid
TXTXB122015Medicare PIN
TX8638K0Medicare ID - Type Unspecified
TX135314613Medicaid
TX135314615Medicaid
TXTXB101403Medicare PIN