Provider Demographics
NPI:1982185716
Name:WILLIS, FRANK BUCHANAN JR (MBBS, PHD, FACSM)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:BUCHANAN
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:MBBS, PHD, FACSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 STEWART RD # 115
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1880
Mailing Address - Country:US
Mailing Address - Phone:409-457-7894
Mailing Address - Fax:
Practice Address - Street 1:6511 STEWART RD STE 7C
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1896
Practice Address - Country:US
Practice Address - Phone:409-457-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30163701175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty