Provider Demographics
NPI:1851333850
Name:WILLIAMSON, GARY W (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2120207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139811722Medicaid
TX8CU714OtherBCBS
TX0042EJOtherBCBS
TX080126648OtherRAIL ROAD
TX75-0818167-022OtherTRICARE
TX75-0818167-048OtherTRICARE
TX8M5091OtherBCBS
TXTIN PLUS 044OtherTRICARE WINNSBORO LOCATION
TX75-2616977OtherRAIL ROAD
TX75-2616977-028OtherTRICARE
TXTIN PLUS 015OtherTRICARE TYLER LOCATION
TX139811714Medicaid
TX75-2616977-001OtherTRICARE
TX139811724Medicaid
TX75-2616977-002OtherTRICARE
TX139811723Medicaid
TXTIN PLUS 005OtherTRICARE
TX139811721Medicaid
TX8L3837Medicare Oscar/Certification
TX315974YMAFMedicare PIN
TX139811722Medicaid
TX0042EJOtherBCBS
TX8CU714OtherBCBS
TX75-2616977-001OtherTRICARE
TX00340LMedicare PIN