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Individual

WALTER WILLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
22451 CHERRY LN, FRANKSTON, TX 75763-4329
(800) 679-8010
(903) 825-6099
Mailing address
22451 CHERRY LN, FRANKSTON, TX 75763-4329
(800) 679-8010
(903) 825-6099

Taxonomy

Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
6836
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
09050686
TX DEPT OF PUBLIC SAFETY
TX
Enumeration date
05/18/2012
Last updated
05/18/2012
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