Healthcare Provider Details

I. General information

NPI: 1932162252
Provider Name (Legal Business Name): HAROLD DAVID WILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 09/13/2021
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HOLDERRIETH BLVD
TOMBALL TX
77375-6445
US

IV. Provider business mailing address

PO BOX 268840
OKLAHOMA CITY OK
73126-8840
US

V. Phone/Fax

Practice location:
  • Phone: 832-687-5787
  • Fax:
Mailing address:
  • Phone: 832-687-5787
  • Fax: 512-532-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberK7951
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK7951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: