Provider Demographics
NPI:1225505266
Name:WILLS, ROGER
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:WILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SW E AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7320
Mailing Address - Country:US
Mailing Address - Phone:580-248-6450
Mailing Address - Fax:580-248-6486
Practice Address - Street 1:1313 W ASH AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4358
Practice Address - Country:US
Practice Address - Phone:580-248-6450
Practice Address - Fax:580-248-6486
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator