Healthcare Provider Details

I. General information

NPI: 1528246402
Provider Name (Legal Business Name): V LEROY WILLITS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15035 EAST FWY
CHANNELVIEW TX
77530-4151
US

IV. Provider business mailing address

15035 EAST FWY
CHANNELVIEW TX
77530-4151
US

V. Phone/Fax

Practice location:
  • Phone: 281-452-3983
  • Fax: 281-452-5168
Mailing address:
  • Phone: 281-452-3983
  • Fax: 281-452-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VERNE LEROY WILLITS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 281-452-3983