Provider Demographics
NPI:1427085497
Name:CHILTON, RAYMOND LEE III (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEE
Last Name:CHILTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:LEE
Other - Last Name:CHILTON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7902 TISDALE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8415
Mailing Address - Country:US
Mailing Address - Phone:512-633-4585
Mailing Address - Fax:512-641-6151
Practice Address - Street 1:5525 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1646
Practice Address - Country:US
Practice Address - Phone:512-371-0911
Practice Address - Fax:512-407-9225
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7931207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128975311Medicaid
TX128975311Medicaid
TXF76320Medicare UPIN