Provider Demographics
NPI:1942231824
Name:WILLIAMS, WILFORD SAMUEL
Entity Type:Individual
Prefix:
First Name:WILFORD
Middle Name:SAMUEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
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 1210
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:TX
Mailing Address - Zip Code:77962-1210
Mailing Address - Country:US
Mailing Address - Phone:361-771-3311
Mailing Address - Fax:361-771-3081
Practice Address - Street 1:204 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:TX
Practice Address - Zip Code:77962-1210
Practice Address - Country:US
Practice Address - Phone:361-771-3311
Practice Address - Fax:361-771-3081
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAW9345528OtherDEA
TXAW9345528OtherDEA
TX8263B0Medicare PIN