MEDICARE: DENNIS E. WILLIS, M.D., P.A..

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	207Q00000X	Family Medicine Physician	K7950	TX

General Provider Information

NPI Number	:	1578510095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS E. WILLIS, M.D., P.A..

Provider Business Mailing Address
First Line	:	PO BOX 171125
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-8125
Country	:	US
Telephone Number	:	210-590-6900
Fax Number	:	210-590-6907

Provider Business Practice Location Address
First Line	:	8711 VILLAGE DR
Second Line	:	SUITE # 325
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5418
Country	:	US
Telephone Number	:	210-590-6900
Fax Number	:	210-590-6907

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENNIS E. WILLIS
Credential	:
Telephone Number	:	210-590-6900

Provider Enumeration Date	:	05/29/2006
Last Update Date	:	08/22/2020

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