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NPI Code Detail

MEDICARE: W. DARRELL WILLERSON JR MD PA

MEDICARE: W. DARRELL WILLERSON JR MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20026NCOTHERTXBCBS

General Provider Information

NPI Number : 1255404943
Entity Type Code : Organization
Provider Name (Legal Business Name) : W. DARRELL WILLERSON JR MD PA
Provider Business Mailing Address
First Line : 303 E QUINCY ST
Second Line : SUITE 100
City : SAN ANTONIO
State : TX
Zip : 78215-1918
Country : US
Telephone Number : 210-271-7648
Fax Number : 210-225-8184
Provider Business Practice Location Address
First Line : 303 E QUINCY ST STE 100
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78215-1922
Country : US
Telephone Number : 210-271-7648
Fax Number : 210-225-8184
Authorized Official
Title or Position : PRESIDENT
Name : WILLIAM DARRELL WILLERSON JR.
Credential : MD
Telephone Number : 210-271-7648
Provider Enumeration Date : 11/17/2006
Last Update Date : 01/15/2013

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