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NPI Code Detail

MEDICARE: MR. MILTON EVANS WILLIS PA

MEDICARE: MR. MILTON EVANS WILLIS 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
1363AM0700XMedical Physician AssistantPA00964TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18Y1053OTHERTXBCBS

General Provider Information

NPI Number : 1881635019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MILTON EVANS WILLIS PA
Provider Business Mailing Address
First Line : PO BOX 714
Second Line :
City : WINNIE
State : TX
Zip : 77665-0714
Country : US
Telephone Number : 409-296-9505
Fax Number : 409-296-2506
Provider Business Practice Location Address
First Line : 538 BROADWAY
Second Line :
City : WINNIE
State : TX
Zip : 77665-7600
Country : US
Telephone Number : 409-296-9505
Fax Number : 409-296-2506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 02/23/2009

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Directions to “ MR. MILTON EVANS WILLIS PA” Practice Location

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