Provider Demographics
NPI:1578510095
Name:DENNIS E. WILLIS, M.D., P.A..
Entity Type:Organization
Organization Name:DENNIS E. WILLIS, M.D., P.A..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-590-6900
Mailing Address - Street 1:PO BOX 171125
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-8125
Mailing Address - Country:US
Mailing Address - Phone:210-590-6900
Mailing Address - Fax:210-590-6907
Practice Address - Street 1:8711 VILLAGE DR
Practice Address - Street 2:SUITE # 325
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5418
Practice Address - Country:US
Practice Address - Phone:210-590-6900
Practice Address - Fax:210-590-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W189Medicare ID - Type Unspecified
TX697509Medicare UPIN