Provider Demographics
NPI:1548269566
Name:WILLIAMSON, ALLEN C JR (DO)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:C
Last Name:WILLIAMSON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD
Mailing Address - Street 2:#501
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2000
Mailing Address - Country:US
Mailing Address - Phone:409-729-2555
Mailing Address - Fax:409-729-2542
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD
Practice Address - Street 2:#501
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2000
Practice Address - Country:US
Practice Address - Phone:409-729-2555
Practice Address - Fax:409-729-2542
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119247804Medicaid
G45010Medicare UPIN
TX8924N0Medicare ID - Type Unspecified