Healthcare Provider Details

I. General information

NPI: 1427085497
Provider Name (Legal Business Name): RAYMOND LEE CHILTON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: R. LEE CHILTON III MD

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 BURNET RD
AUSTIN TX
78756-1646
US

IV. Provider business mailing address

7902 TISDALE DR UNIT A
AUSTIN TX
78757-8415
US

V. Phone/Fax

Practice location:
  • Phone: 512-371-0911
  • Fax: 512-407-9225
Mailing address:
  • Phone: 512-633-4585
  • Fax: 512-641-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ7931
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: