Provider Demographics
NPI:1811196207
Name:WILLIAMSON, KEITH EDWARD (PA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EDWARD
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:E
Other - Last Name:GOIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:108 SOUTH WILLIAMS BARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4542
Mailing Address - Country:US
Mailing Address - Phone:281-592-9775
Mailing Address - Fax:281-432-0548
Practice Address - Street 1:108 SOUTH WILLIAMS BARNETT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4542
Practice Address - Country:US
Practice Address - Phone:281-592-9775
Practice Address - Fax:281-432-0548
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02083363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical