Provider Demographics
NPI:1740285329
Name:WILLIAMS, KENNETH (DPM)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 E HOUSTON ST
Mailing Address - Street 2:RM 202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-2953
Mailing Address - Country:US
Mailing Address - Phone:210-225-5804
Mailing Address - Fax:210-225-1046
Practice Address - Street 1:1954 E HOUSTON ST
Practice Address - Street 2:RM 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2953
Practice Address - Country:US
Practice Address - Phone:210-225-5804
Practice Address - Fax:210-225-1046
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018768401Medicaid
TX480028093Medicare PIN
TX018768401Medicaid
TX00L13NMedicare PIN
TX0044AZMedicare PIN
TX5795060001Medicare NSC
TX8A2667Medicare PIN
TX8C0305Medicare PIN