Provider Demographics
NPI:1811915895
Name:WILLS, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:WILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 TRINITY MILLS RD # 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6202
Mailing Address - Country:US
Mailing Address - Phone:972-862-8600
Mailing Address - Fax:972-307-5963
Practice Address - Street 1:3427 TRINITY MILLS RD # 800
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6202
Practice Address - Country:US
Practice Address - Phone:972-862-8600
Practice Address - Fax:972-307-5963
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129827506Medicaid
TX045059502Medicaid
TX045059503Medicaid
TX045059501Medicaid
TXTXB121634Medicare PIN
TXTXB121633Medicare PIN
TX8697J1Medicare PIN
TX045059501Medicaid
TX8G0228Medicare PIN
TX8L3562Medicare PIN
TX129827506Medicaid