MEDICARE: DR. DAVID BARRY WILLINGHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	H0947	TX
2	207QA0505X	Adult Medicine Physician	H9047	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8J3983	OTHER	TX	BCBS PROVIDER NUMBER
2	H0947	OTHER	TX	TX LICENSE NUMBER

General Provider Information

NPI Number	:	1467441642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BARRY WILLINGHAM M.D.

Provider Business Mailing Address
First Line	:	4222 WENDOVER AVE
Second Line	:	SUITE 600
City	:	ODESSA
State	:	TX
Zip	:	79762-5945
Country	:	US
Telephone Number	:	432-552-5656
Fax Number	:	432-552-0992

Provider Business Practice Location Address
First Line	:	4222 WENDOVER AVE
Second Line	:	SUITE 600
City	:	ODESSA
State	:	TX
Zip	:	79762-5945
Country	:	US
Telephone Number	:	432-552-5656
Fax Number	:	432-552-0992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/02/2010

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