Provider Demographics
NPI:1841762556
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:OWNER
Authorized Official - Prefix:
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:936-890-8000
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:936-494-4440
Practice Address - Street 1:804 W MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8830
Practice Address - Country:US
Practice Address - Phone:936-890-8000
Practice Address - Fax:936-890-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty