Provider Demographics
NPI:1558592337
Name:WILLIAMSON, JONATHAN LEVI (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEVI
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4343 PAN AMERICAN FWY NE STE 234
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6831
Mailing Address - Country:US
Mailing Address - Phone:505-880-1000
Mailing Address - Fax:505-880-1002
Practice Address - Street 1:10511 GOLF COURSE RD NW STE 203
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5917
Practice Address - Country:US
Practice Address - Phone:505-872-3333
Practice Address - Fax:505-880-1002
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM327213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14207877Medicaid
NM14207877Medicaid