Provider Demographics
NPI:1669563516
Name:WILLIAMS, EMBRY W III (MD)
Entity type:Individual
Prefix:
First Name:EMBRY
Middle Name:W
Last Name:WILLIAMS
Suffix:III
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 1:375 MUNICIPAL DRIVE
Mailing Address - Street 2:SUITE 236
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-690-8100
Mailing Address - Fax:972-690-8167
Practice Address - Street 1:375 MUNICIPAL DRIVE
Practice Address - Street 2:SUITE 236
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-690-8100
Practice Address - Fax:972-690-8167
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4689207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C23550Medicare UPIN
00JZ29Medicare ID - Type Unspecified