Provider Demographics
NPI:1477040038
Name:WILLIS, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WILLIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7832 PAT BOOKER RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2601
Mailing Address - Country:US
Mailing Address - Phone:210-657-9338
Mailing Address - Fax:210-729-7486
Practice Address - Street 1:7832 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2601
Practice Address - Country:US
Practice Address - Phone:210-657-9338
Practice Address - Fax:210-729-7486
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7083207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology