Provider Demographics
NPI:1720076573
Name:WILLIAMS, JOHN HAROLD (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HAROLD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17198 ST LUKES WAY
Mailing Address - Street 2:#440
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8011
Mailing Address - Country:US
Mailing Address - Phone:936-321-1009
Mailing Address - Fax:936-321-1045
Practice Address - Street 1:17198 ST LUKES WAY
Practice Address - Street 2:#440
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8011
Practice Address - Country:US
Practice Address - Phone:936-266-2525
Practice Address - Fax:936-321-1045
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5416207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE
TX131944410Medicaid
TX131944410Medicaid