Provider Demographics
NPI:1144215815
Name:LEBAS, WILLA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLA
Middle Name:MARIE
Last Name:LEBAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4321
Mailing Address - Country:US
Mailing Address - Phone:281-332-6949
Mailing Address - Fax:281-332-6965
Practice Address - Street 1:380 E MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4321
Practice Address - Country:US
Practice Address - Phone:281-332-6949
Practice Address - Fax:281-332-6965
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDE5776OtherMEDICARE, RAILROAD
TXDE5776OtherMEDICARE, RAILROAD
TX8F1849Medicare ID - Type Unspecified