Provider Demographics
NPI:1104037639
Name:MCWILLIAMS, JEFFREY G SR (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:MCWILLIAMS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFFERY
Other - Middle Name:
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:112 OAK ISLE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605
Mailing Address - Country:US
Mailing Address - Phone:903-663-0396
Mailing Address - Fax:
Practice Address - Street 1:1300 N 6TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5567
Practice Address - Country:US
Practice Address - Phone:903-232-8928
Practice Address - Fax:903-234-1639
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7143208D00000X, 207P00000X
LAMD203850207P00000X
OK269656207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216797510Medicaid
LA09891Medicaid