Individual
MR. MILTON EVANS WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
538 BROADWAY, WINNIE, TX 77665-7600
(409) 296-9505
(409) 296-2506
Mailing address
PO BOX 714, WINNIE, TX 77665-0714
(409) 296-9505
(409) 296-2506
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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