Provider Demographics
NPI:1316940372
Name:WILLIS, DONALD L (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 REDWOOD RD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-1423
Mailing Address - Country:US
Mailing Address - Phone:512-396-4400
Mailing Address - Fax:512-396-4403
Practice Address - Street 1:1601 REDWOOD RD
Practice Address - Street 2:STE A
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-1423
Practice Address - Country:US
Practice Address - Phone:512-396-4400
Practice Address - Fax:512-396-4403
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-07-06
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Provider Licenses
StateLicense IDTaxonomies
TXG5783208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B09HMedicare ID - Type Unspecified
TX2323595Medicare UPIN