Provider Demographics
NPI:1942422738
Name:WILLINGHAM, NEALAND OLIVER II (DPM)
Entity Type:Individual
Prefix:
First Name:NEALAND
Middle Name:OLIVER
Last Name:WILLINGHAM
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 COLONNADE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6174
Mailing Address - Country:US
Mailing Address - Phone:254-776-6995
Mailing Address - Fax:254-776-5577
Practice Address - Street 1:201 COLONNADE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6174
Practice Address - Country:US
Practice Address - Phone:254-776-6995
Practice Address - Fax:254-776-5577
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1823213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187108901Medicaid
TX8M5112OtherBCBS
TXP00418436OtherMEDICARE RAILROAD
TX8J7706Medicare PIN
TX8M5112OtherBCBS