DAN A. WILLIS, M.D., P.A.
Medical Practice at Pennsylvania Ave, Fort Worth, TX

License number
Texas E2944
Category
Medical Practice
Type
Ophthalmology
Owner
Name: DR. DAN A WILLIS M.D.
Title: PRESIDENT
Phone: (817) 877-5382
Address
Address
1325 Pennsylvania Ave STE 670, Fort Worth, TX 76104
National Provider ID: 1649418831
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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DAN A. WILLIS, M.D., PA

Fort Worth, TX

Status:
Inactive
Doing business as:
Dan A. Willis, M.D., PA
Registration:
Dec 19, 2002
Addresses:
6420 SW Blvd STE 133, Fort Worth, TX 76109 (Mailing)
1325 Pennsylvania Ave, Fort Worth, TX 76104
State ID:
0800154140
Business type:
Professional Association
President , Treasurer , Director , Member , Secretary , Vice-President:
Dan A. Willis President , Treasurer , Director , Member , Secretary , Vice-President, inactive
TIN:
32035825341

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