Provider Demographics
NPI:1215183512
Name:WILLIAMSON, DAVID ALLAN (MB, CHB)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLAN
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MB, CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25511 HAVEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2630
Mailing Address - Country:US
Mailing Address - Phone:410-463-0560
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERWAY STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1993
Practice Address - Country:US
Practice Address - Phone:713-589-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR09772084B0040X, 2084P0301X
MDD437562084B0040X
TXD437562084P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65861Medicare UPIN