Individual
THOMAS J WILLIS
Active
Individual
THOMAS J WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01081254A
IN
207L00000X
Anesthesiology Physician
P6551
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430C49
MEDICARE PTAN
IN
05
—
300020977
—
IN
01
—
Q00202320
MEDICARE PTAN
IN
Enumeration date
03/31/2009
Last updated
11/28/2023
Update your record
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