Provider Demographics
NPI:1194155382
Name:WILLIS L STARNES MD PHD
Entity type:Organization
Organization Name:WILLIS L STARNES MD PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIGOVSKAIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:214-298-5528
Mailing Address - Street 1:3204 N MACARTHUR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-8804
Mailing Address - Country:US
Mailing Address - Phone:972-256-2028
Mailing Address - Fax:972-670-5672
Practice Address - Street 1:3204 N MACARTHUR BLVD STE A
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8804
Practice Address - Country:US
Practice Address - Phone:972-256-2028
Practice Address - Fax:972-670-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08480261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care