Provider Demographics
NPI:1861682700
Name:CLOSE, WILL E (MD)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:E
Last Name:CLOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROSALIND REDFERN GROVER PKWY
Mailing Address - Street 2:RADIOLOGY DEPT
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5846
Mailing Address - Country:US
Mailing Address - Phone:432-221-2730
Mailing Address - Fax:432-221-1075
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5846
Practice Address - Country:US
Practice Address - Phone:432-221-2730
Practice Address - Fax:432-221-1075
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP38702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1077259Medicaid
CACB221813Medicare PIN
TXTXB155549Medicare PIN