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General NPI Number Information
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NPI Number | 1235159096
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Entity Type | Organization
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Legal Business Name | WILLIS, HALTER AND ASSOCIATES
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 402 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3123
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Country | US
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Telephone | 936-634-7522
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Fax | 936-639-4549
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Provider Business Mailing Address
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Address Line | 402 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3123
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Country | US
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Telephone | 936-634-7522
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Fax | 936-639-4549
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS LESTER WILLIS
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Credential | M D
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Telephone | 936-634-7522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0080941103
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License Number State | TX
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