Provider Demographics
NPI:1770691354
Name:BARRY G WILLENS MD PA
Entity type:Organization
Organization Name:BARRY G WILLENS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:281-689-8144
Mailing Address - Street 1:20185 US HIGHWAY 59
Mailing Address - Street 2:SUITE 72
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-8358
Mailing Address - Country:US
Mailing Address - Phone:281-689-8144
Mailing Address - Fax:281-399-8904
Practice Address - Street 1:20185 US HIGHWAY 59
Practice Address - Street 2:SUITE 72
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-8358
Practice Address - Country:US
Practice Address - Phone:281-689-8144
Practice Address - Fax:281-399-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-09-09
Deactivation Date:2007-11-05
Deactivation Code:
Reactivation Date:2010-09-09
Provider Licenses
StateLicense IDTaxonomies
TXG9676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJQ72OtherBLUE CROSS BLUE SHIELD TX