Provider Demographics
NPI:1316996655
Name:WILLIAMSON, RICHARD WALLIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WALLIS
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5000 LONG PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2783
Mailing Address - Country:US
Mailing Address - Phone:972-420-1776
Mailing Address - Fax:972-436-6996
Practice Address - Street 1:5000 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2783
Practice Address - Country:US
Practice Address - Phone:972-420-1776
Practice Address - Fax:972-436-6996
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6211207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00642536OtherRAILROAD MEDICARE
TX035301302Medicaid
TX8BF127OtherBLUECROSS
TX8F8063Medicare PIN
TX8BF127OtherBLUECROSS
TX035301302Medicaid