Provider Demographics
NPI:1770321432
Name:WILLIAMS COCKBURN, EPHRAIM WELLINGTON
Entity type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:WELLINGTON
Last Name:WILLIAMS COCKBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:EPHRAIM
Other - Middle Name:WELLINGTON
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1033 BROCK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3343
Mailing Address - Country:US
Mailing Address - Phone:361-876-4477
Mailing Address - Fax:
Practice Address - Street 1:SERGIO CUEVAS ST. #550
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:361-876-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program