Willie, Glen Robert

Willie, Glen Robert is an sole proprietor health care provider with primary practice located at 900 N Armstrong Ave , Denison TX 75020-2230. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Nephrology, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Willie, Glen Robert can be contacted via phone (903) 465-2440.

Contact Information

Primary practice address
900 N Armstrong Ave Denison TX 75020-2230
Phone: (903) 465-2440
Fax: (903) 465-2298
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X G0858 Texas
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X G0858 Texas
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X G0858 Texas

Profile Details

NPI number 1205887973
LBN Legal business name Willie, Glen Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 15th, 2006
Last updated Dec 15th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205887973 NPPES
Texas Other 86170Y BLUE CROSS BLUE SHIELD
Texas MEDICAID 122390105 BLUE CROSS BLUE SHIELD

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