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General NPI Number Information
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NPI Number | 1053645838
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Entity Type | Organization
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Legal Business Name | MARTA WILLOUGHBY MD PA
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 3423 CALDERA
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City | MIDLAND
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State | TX
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Zip | 79707
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Country | US
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Telephone | 432-699-6271
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Fax | 432-699-6296
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Provider Business Mailing Address
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Address Line | 5600 HEARTLAND COURT
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City | MIDLAND
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State | TX
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Zip | 79707-1111
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Country | US
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Telephone | 432-218-8880
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Fax | 432-218-8880
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTA G WILLOUGHBY
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Credential | MD
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Telephone | 432-218-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | M2204
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License Number State | TX
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