Individual
GLEN ROBERT WILLIE
Active
Individual
GLEN ROBERT WILLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G0858
TX
207R00000X
Internal Medicine Physician
Primary
G0858
TX
207RN0300X
Nephrology Physician
G0858
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122390105
—
TX
01
—
86170Y
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/15/2006
Last updated
12/15/2022
Update your record
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