Provider Demographics
NPI:1932103629
Name:WILLIAMS, BALMORE W (MD)
Entity Type:Individual
Prefix:
First Name:BALMORE
Middle Name:W
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 1:202 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327
Mailing Address - Country:US
Mailing Address - Phone:281-592-2656
Mailing Address - Fax:281-592-9723
Practice Address - Street 1:202 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327
Practice Address - Country:US
Practice Address - Phone:281-592-2656
Practice Address - Fax:281-592-9723
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144323602Medicaid
TX8143693OtherCIGNA
TX7486286OtherAETNA
TX8B9860OtherBCBS PROVIDER NUMBER
TX144323601Medicaid
TX8143693OtherCIGNA
TX8F9361Medicare Oscar/Certification
TX8F9361Medicare PIN