Provider Demographics
NPI:1871546408
Name:WILLIAMSON, SCOTT LEE (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEE
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 1:16538 WEST 159TH TERR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-829-1660
Mailing Address - Fax:913-829-1770
Practice Address - Street 1:16538 WEST 159TH TERR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-829-1660
Practice Address - Fax:913-829-1770
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200356810AMedicaid
KS033E182DMedicare PIN
C23583Medicare UPIN