Organization
ROGER C WILLETTE MD; PA
Active
Other names
Roger C Willette MD; PA
Organization subpart
No
Provider details
NPI number
Authorized official
CAREY KNEUPPER (PRACTICE ADMINISTRATOR)
(281) 333-1213
Entity
Organization
Contact information
Practice address
1322 SPACE PARK DR, STE B150, HOUSTON, TX 77058-3400
(281) 333-1213
(281) 333-9573
Mailing address
PO BOX 57805, WEBSTER, TX 77598-7805
(281) 333-1213
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G6771
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097810801
—
TX
Enumeration date
06/23/2008
Last updated
07/08/2008
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