Provider Demographics
NPI:1154416600
Name:WILLS, MARTHA PAULINE (MD, FACS, PA)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:PAULINE
Last Name:WILLS
Suffix:
Gender:F
Credentials:MD, FACS, PA
Other - Prefix:
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Mailing Address - Street 1:10840 TEXAS HEALTH TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6848
Mailing Address - Country:US
Mailing Address - Phone:817-595-8822
Mailing Address - Fax:817-595-8833
Practice Address - Street 1:10840 TEXAS HEALTH TRL STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6848
Practice Address - Country:US
Practice Address - Phone:817-595-8822
Practice Address - Fax:817-595-8833
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0367208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8868Medicare PIN
TXG10068Medicare UPIN