Provider Demographics
NPI:1891930459
Name:DWAYNE O. WILLIAMS, M.D., P.A.
Entity Type:Organization
Organization Name:DWAYNE O. WILLIAMS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-238-3100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131699407Medicaid
TXE30407Medicare UPIN
TX131699407Medicaid