Dallas Omar McWilliams, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

101 Bodin Cir
Fairfield, CA 94535-1809

Phone

(707) 423-3000

NPI assigned

Oct 2, 2020

Last updated

Jun 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1912504093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 126TH STREET CT E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984457100",
            "telephone_number": "253-223-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCWILLIAMS",
        "first_name": "DALLAS",
        "middle_name": "OMAR",
        "name_prefix": "Mr.",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-02",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shalon McMiller
• Shayla McNeal
• Kyle McNulty, DDS
• Anne McPheeters
• Wendy Michaela McStravick
• Alexander Russell Meade, DDS
• Shahrzad Mease, LMFT
• Azucena Medina-Carrasco
• Josie Medina
• Manuel Amado Medina

• Independent Duty Medical Technicians in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Independent Duty Medical Technicians in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; 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.