Provider Demographics
NPI:1053307264
Name:WILLS, PATRICK WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WAYNE
Last Name:WILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5126 DOLIVER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-2408
Mailing Address - Country:US
Mailing Address - Phone:713-569-8150
Mailing Address - Fax:281-929-0585
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8235
Practice Address - Country:US
Practice Address - Phone:281-868-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097755502Medicaid
TX110130882OtherRAIL ROAD MEDICARE
TX10014444OtherAMERIGROUP
TX80K111Medicare PIN
TXC23602Medicare UPIN