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General NPI Number Information
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NPI Number | 1053593608
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Entity Type | Organization
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Legal Business Name | MARTHA P. WILLS, M.D., F.A.C.S., PA
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 4375 BOOTH CALLOWAY RD 507
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-8359
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Country | US
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Telephone | 817-595-8822
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Fax | 817-595-8833
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Provider Business Mailing Address
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Address Line | 4375 BOOTH CALLOWAY RD 507
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-8359
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Country | US
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Telephone | 817-595-8822
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Fax | 817-595-8833
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTHA PAULINE WILLS
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Credential | M.D.
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Telephone | 817-595-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J0367
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License Number State | TX
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