AUSTIN GLENN WILLIS

ALBUQUERQUE, NM
NPI1083034920
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy208000000X Pediatrics
(Licence: NM  A-2075-17)
Additional Taxonomies208000000X Pediatrics
(Licence: TX  BP1-0059381)
Enumeration Date2014-04-18
Last Update Date2022-07-21
Business Address
-- AUSTIN GLENN WILLIS DO
1100 CENTRAL AVE SE
ALBUQUERQUE, NM 87106-4930
Phone number: 505-841-1063
Mailing Address
-- AUSTIN GLENN WILLIS DO
PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE, NM 87125-6666
Phone number: 505-923-6770
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