Individual
TONI WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3020 W WHEATLAND RD, DALLAS, TX 75237-3537
(972) 708-8667
(972) 708-8692
Mailing address
2600 E SOUTHLAKE BLVD, SUITE 120-293, SOUTHLAKE, TX 76092-6634
(817) 723-6378
(972) 708-8692
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
L0703
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160493601
—
TX
01
—
3258HM
BLUE CROSS BLUE SHIELD
TX
01
—
P00067292
RAILROAD MEDICARE
—
Enumeration date
06/27/2006
Last updated
09/27/2010
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