Individual
WILL E CLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 ROSALIND REDFERN GROVER PKWY, RADIOLOGY DEPT, MIDLAND, TX 79701-5846
(432) 221-2730
(432) 221-1075
Mailing address
400 ROSALIND REDFERN GROVER PKWY, RADIOLOGY DEPT, MIDLAND, TX 79701-5846
(432) 221-2730
(432) 221-1075
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
P3870
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1077259
—
LA
Enumeration date
07/26/2007
Last updated
05/03/2017
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