Provider Demographics
NPI:1922194117
Name:WILLINGHAM, SIMONE (MD)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NASA PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3607
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2101 NASA PKWY
Practice Address - Street 2:MAIL STOP SD22
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3607
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL20562083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145743401Medicaid
TX145743403Medicaid
TX145743402Medicaid
TX8096N1Medicare PIN
TX8386N4Medicare PIN
TX8385N3Medicare PIN