Provider Demographics
NPI:1861490005
Name:WILLIAMS, COLVILLE T
Entity type:Individual
Prefix:DR
First Name:COLVILLE
Middle Name:T
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 1:7015 ALMEDA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2101
Mailing Address - Country:US
Mailing Address - Phone:713-654-0808
Mailing Address - Fax:
Practice Address - Street 1:7015 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2101
Practice Address - Country:US
Practice Address - Phone:713-654-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133606702Medicaid
TX207RN0300XOtherTAXONOMY CODE
TX0025BAMedicare ID - Type Unspecified
TXG10446Medicare UPIN