Basic Information
| Provider Information | |||||||||
| NPI: | 1386683423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2099 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782972099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105586288 | ||||||||
| FaxNumber: | 2105586289 | ||||||||
| Practice Location | |||||||||
| Address1: | 8026 FLOYD CURL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105586288 | ||||||||
| FaxNumber: | 2105586289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L0702 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.