Carl Robert Williams Jr., P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00167 Issued in TX

Practice address

315 Cameron TRL
Lakehills, TX 78063-6262

Phone

(210) 232-4981

NPI assigned

Sep 17, 2008

Last updated

Mar 26, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DHHS PHS Naihs Fort Defiance Hospital

  dba PHS Fort Defiance Indian Hospital

  • General Acute Care Hospital
  • Fort Defiance, AZ
  • NPI 1700962131
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364256000000",
    "number": "1780833533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 CAMERON TRL",
            "city": "LAKEHILLS",
            "state": "TX",
            "postal_code": "780636262",
            "telephone_number": "830-751-2907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 CAMERON TRL",
            "city": "LAKEHILLS",
            "state": "TX",
            "postal_code": "780636262",
            "telephone_number": "210-232-4981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CARL",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "P.A.-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-17",
        "last_updated": "2013-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA00167",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "PA 2328",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTRAL CONTRACTOR REGISTRATION; TRADING PARTNER IDENTIFICATION NUMBER",
            "identifier": "24913710",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Medina Lake Clinic PA
• San Antonio Caring Angels, LLC
• Kimberly Marie Tench, MSN, FNP-C
• Underway Anesthesia Services, PLLC
• Warrior Wellness and Recovery Initiative: Warriors Healing Warriors, PLLC

• Medical Physician Assistant in Lakehills, TX
• Providers in Lakehills, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.