Provider Demographics
NPI:1538295167
Name:MCGUIRE, WILLARD LEO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:LEO
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1102 DOVE LN
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2860
Mailing Address - Country:US
Mailing Address - Phone:940-569-3399
Mailing Address - Fax:
Practice Address - Street 1:1102 DOVE LN
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-2860
Practice Address - Country:US
Practice Address - Phone:940-569-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01008363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01008OtherLICENSE