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NPI Code Detail

MEDICARE: TONI WILLIS MD

MEDICARE: TONI WILLIS MD
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
1208100000XPhysical Medicine & Rehabilitation PhysicianL0703TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00067292OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33258HMOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1316974124
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONI WILLIS MD
Provider Business Mailing Address
First Line : 2600 E SOUTHLAKE BLVD
Second Line : SUITE 120-293
City : SOUTHLAKE
State : TX
Zip : 76092-6634
Country : US
Telephone Number : 817-723-6378
Fax Number : 972-708-8692
Provider Business Practice Location Address
First Line : 3020 W WHEATLAND RD
Second Line :
City : DALLAS
State : TX
Zip : 75237-3537
Country : US
Telephone Number : 972-708-8667
Fax Number : 972-708-8692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 09/27/2010

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Directions to “ TONI WILLIS MD” Practice Location

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