Provider Demographics
NPI:1174602957
Name:WILLIAMS, KELVIN R
Entity type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8868 RESEARCH BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6497
Mailing Address - Country:US
Mailing Address - Phone:512-326-4714
Mailing Address - Fax:512-326-4700
Practice Address - Street 1:8868 RESEARCH BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6497
Practice Address - Country:US
Practice Address - Phone:512-326-4714
Practice Address - Fax:512-326-4700
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0076001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4831020001Medicare NSC