Keith Allen Wixtrom, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G8515 Issued in TX

Practice address

7916 S Broadway Ave
Tyler, TX 75703-5274

Phone

(903) 266-5900

Fax

(214) 276-7333

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physician Associates of Southwest Dallas

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1801845425
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1639193246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 HIDE A WAY LN C",
            "city": "HIDEAWAY",
            "state": "TX",
            "postal_code": "757715202",
            "telephone_number": "214-663-8244",
            "fax_number": "214-276-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7916 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035274",
            "telephone_number": "903-266-5900",
            "fax_number": "214-276-7333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3250 W Pleasant Run Rd",
            "address_2": "Suite 160",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "TX",
            "postal_code": "751461050",
            "country_code": "US",
            "telephone_number": "972-274-5200",
            "fax_number": "972-274-5217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 S Lancaster Rd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752167167",
            "country_code": "US",
            "telephone_number": "214-857-1911",
            "fax_number": "214-276-7333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIXTROM",
        "first_name": "KEITH",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G8515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Garrett Wise
• Sarah Withers, RN
• Douglas Witte, DDS MS
• Maxine Julia Witteveen
• Lyndsey M Wittig
• Cristina Rosamaria Wohlgehagen, M.D.
• Hailegiorgis A Woldegiorgis, MD
• Dejene Woldemariam, PHARMD
• Angela Wolf
• Scott William Wolf, MD

• Family Medicine Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.