Individual
MR. MILTON EVANS WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00964
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8Y1053
BCBS
TX
Enumeration date
06/09/2006
Last updated
02/23/2009
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