Provider Demographics
NPI:1588645014
Name:WILLIS, ARTHUR WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:WILLIAM
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4069
Mailing Address - Street 2:DEPT. 4069-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4069
Mailing Address - Country:US
Mailing Address - Phone:713-799-9975
Mailing Address - Fax:713-799-1095
Practice Address - Street 1:2727 GRAMERCY
Practice Address - Street 2:STE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-799-9975
Practice Address - Fax:713-799-1095
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE0646207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137709504Medicaid
C23589Medicare UPIN
TX137709504Medicaid