Provider Demographics
NPI:1073566709
Name:WILLIAMSON, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:WILLIAMSON
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 1:1020 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2009
Mailing Address - Country:US
Mailing Address - Phone:512-687-1950
Mailing Address - Fax:512-687-1490
Practice Address - Street 1:4007 JAMES CASEY ST
Practice Address - Street 2:C150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3369
Practice Address - Country:US
Practice Address - Phone:512-443-5988
Practice Address - Fax:512-443-5055
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6690208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114581504Medicaid
8F6342Medicare PIN