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General NPI Number Information
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NPI Number | 1376592477
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Entity Type | Individual
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Provider Name | WALTER J WILLOUGHBY JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 10105 BANBURRY CROSS DR STE 355
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City | LAS VEGAS
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State | NV
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Zip | 89144-6649
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Country | US
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Telephone | 702-409-3069
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Fax | 702-473-1869
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Provider Business Mailing Address
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Address Line | 10105 BANBURRY CROSS DR STE 355
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City | LAS VEGAS
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State | NV
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Zip | 89144-6649
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Country | US
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Telephone | 702-409-3069
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Fax | 702-473-1869
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 4004
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 4004
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 4004
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License Number State | NV
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