1518922657 NPI number — DR. ALDON BYRON WILLIAMS M.D.

Table of content: DR. ALDON BYRON WILLIAMS M.D. (NPI 1518922657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518922657 NPI number — DR. ALDON BYRON WILLIAMS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
ALDON
Provider Middle Name:
BYRON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518922657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 N EXPRESSWAY 77/83
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78526-4354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-350-0900
Provider Business Mailing Address Fax Number:
956-350-0906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 N EXPRESSWAY 77/83
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78526-4354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-350-0900
Provider Business Practice Location Address Fax Number:
956-350-0906
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  J8418 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050092207 . This is a "INDIV MEDICARE RR#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8H0762 . This is a "INDIVIDUAL BCBS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 101960100 . This is a "INDIV VALLEY HEALTH PLAN#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 042904503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00454599 . This is a "MEDICARE RAILROAD-PA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 042904504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8BC490 . This is a "BLUE CROSS BLUE SHIELD TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: J8418 . This is a "LICENSE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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