Provider Demographics
NPI:1508249798
Name:CONROE WILLIS FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:CONROE WILLIS FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:LANINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-441-1122
Mailing Address - Street 1:4015 I 45 N STE 220
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5076
Mailing Address - Country:US
Mailing Address - Phone:936-441-1122
Mailing Address - Fax:936-788-9151
Practice Address - Street 1:4015 I 45 N STE 220
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5076
Practice Address - Country:US
Practice Address - Phone:936-441-1122
Practice Address - Fax:936-788-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty