Provider Demographics
NPI:1558342634
Name:WILLINGHAM, ALEX CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:CLARK
Last Name:WILLINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SPURS LANE BLDG 6 SUITE 100
Mailing Address - Street 2:SOUTH TEXAS PM&R GROUP, INC.
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-615-2225
Mailing Address - Fax:210-615-8432
Practice Address - Street 1:2 SPURS LANE BLDG 6 SUITE 100
Practice Address - Street 2:SOUTH TEXAS PM&R GROUP, INC.
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-615-2225
Practice Address - Fax:210-615-8432
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1249208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1348369-02Medicaid
TXH1249OtherTEXAS MEDICAL LICENSE
TX1348369-02Medicaid
TXC23588Medicare UPIN