Healthcare Provider Details

I. General information

NPI: 1104037639
Provider Name (Legal Business Name): JEFFREY G MCWILLIAMS SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFERY MCWILLIAMS M.D.

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 6TH ST UNIT A
LONGVIEW TX
75601-5567
US

IV. Provider business mailing address

112 OAK ISLE
LONGVIEW TX
75605
US

V. Phone/Fax

Practice location:
  • Phone: 903-232-8928
  • Fax: 903-234-1639
Mailing address:
  • Phone: 903-663-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberN7143
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN7143
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD203850
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number269656
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: