Provider Demographics
NPI:1740732825
Name:WILLIAMS, ROGER CHARLES JR (AP132109)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:CHARLES
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:AP132109
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-2746
Mailing Address - Country:US
Mailing Address - Phone:806-743-9355
Mailing Address - Fax:806-743-9363
Practice Address - Street 1:301 40TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-2746
Practice Address - Country:US
Practice Address - Phone:806-743-9355
Practice Address - Fax:806-743-9363
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily