Provider Demographics
NPI:1528246402
Name:V LEROY WILLITS MD PA
Entity type:Organization
Organization Name:V LEROY WILLITS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNE
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WILLITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-452-3983
Mailing Address - Street 1:15035 EAST FWY
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4151
Mailing Address - Country:US
Mailing Address - Phone:281-452-3983
Mailing Address - Fax:281-452-5168
Practice Address - Street 1:15035 EAST FWY
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4151
Practice Address - Country:US
Practice Address - Phone:281-452-3983
Practice Address - Fax:281-452-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0054AUOtherBCBS
TX0A3472Medicare PIN