Active NPI
Willis Crocker Maddrey, MD
- Hepatology Physician
- Dallas, TX
National Provider Identifier
1528037009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hepatology Physician
- License
- H9737
- Practice address
- 5323 Harry Hines Blvd
Dallas, TX 75390-7208 - Phone
- (214) 645-0624
- Fax
- (214) 645-0078
- NPI assigned
- Mar 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hepatology Physician | 207RI0008X | H9737 | TX | Primary |
Addresses
Primary practice location
5323 Harry Hines Blvd
Dallas, TX 75390-7208
Mailing address
PO Box 845347
Dallas, TX 75284-5347
Phone (214) 645-0624
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 045986901 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H9737 | TX | MD | Hepatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1528037009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 845347",
"city": "DALLAS",
"state": "TX",
"postal_code": "752845347",
"telephone_number": "214-645-0624",
"fax_number": "214-645-0078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5323 HARRY HINES BLVD",
"city": "DALLAS",
"state": "TX",
"postal_code": "753907208",
"telephone_number": "214-645-0624",
"fax_number": "214-645-0078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDREY",
"first_name": "WILLIS",
"middle_name": "CROCKER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-16",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0008X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hepatology",
"state": "TX",
"license": "H9737",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "045986901",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.