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NPI Code Detail

MEDICARE: WALTER J WILLOUGHBY JR. MD

MEDICARE: WALTER J WILLOUGHBY JR. 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
1207RC0200XCritical Care Medicine (Internal Medicine) Physician4004NV
2207RS0012XSleep Medicine (Internal Medicine) Physician4004NV
3207RP1001XPulmonary Disease Physician4004NV

Other Identifiers

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

General Provider Information

NPI Number : 1376592477
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER J WILLOUGHBY JR. MD
Provider Business Mailing Address
First Line : 10105 BANBURRY CROSS DR STE 355
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6649
Country : US
Telephone Number : 702-409-3069
Fax Number : 702-473-1869
Provider Business Practice Location Address
First Line : 10105 BANBURRY CROSS DR STE 355
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6649
Country : US
Telephone Number : 702-409-3069
Fax Number : 702-473-1869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 11/03/2025

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Directions to “ WALTER J WILLOUGHBY JR. MD” Practice Location

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