Provider Demographics
NPI:1336349448
Name:WILLIAMS, DEREK EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:EDWIN
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 1:2821 E PRESIDENT GEORGE BUSH HWY STE 404
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4278
Mailing Address - Country:US
Mailing Address - Phone:214-943-2200
Mailing Address - Fax:214-943-2201
Practice Address - Street 1:2821 E. PRESIDENT GEORGE BUSH TURNPIKE
Practice Address - Street 2:SUITE 404
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082
Practice Address - Country:US
Practice Address - Phone:214-943-2200
Practice Address - Fax:214-943-2201
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0321208G00000X
FLME124590208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015147600Medicaid
FLIG181ZMedicare PIN