Individual
SELWYN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
609 E WHALEY ST, LONGVIEW, TX 75601-6526
(903) 753-3316
(903) 753-4344
Mailing address
PO BOX 2202, LONGVIEW, TX 75606-2202
(903) 753-3316
(903) 753-3316
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018656101
—
TX
Enumeration date
06/22/2005
Last updated
12/16/2011
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