Organization
CHARLES E. WILLIS II, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES E. WILLIS II M.D. (PRESIDENT)
(214) 623-0550
Entity
Organization
Contact information
Practice address
5201 S WESTMORELAND RD, DALLAS, TX 75237-1622
(214) 623-0550
Mailing address
PO BOX 1347, ADDISON, TX 75001-1347
(972) 991-9950
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
J0365
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R03P
BCBS
TX
05
—
162314201
—
TX
Enumeration date
02/27/2007
Last updated
05/10/2008
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