Provider Demographics
NPI:1548376668
Name:WILLIAMS, KEVIN ALEXANDER (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ALEXANDER
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 1:802 W LAMPASAS ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:972-875-4700
Mailing Address - Fax:972-878-2238
Practice Address - Street 1:802 W LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-875-4700
Practice Address - Fax:972-878-2238
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8575207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030815701Medicaid
TX030815701Medicaid