Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD424463 | PA |
N | 208600000X | Surgeon | MD424463 | PA |
Y | 2086X0206X | Surgical Oncologist | MD424463 | PA |
NPI | 1366475287 |
---|---|
Provider Name | Alliric I. Willis |
First Address | Philadelphia, PA 19107-5563 |
Second Address | Philadelphia, PA 19107-5563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 17/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1016680610001 | (05) | PA |
1016680610004 | (05) | PA |
1621481 | HIGHMARK BLUE SHIELD (01) | PA |
1621481 | PERSONAL CHOICE (01) | PA |
2298641000 | KEYSTONE IBC (01) | PA |
30032812 | KEYSTONE MERCY (01) | PA |
35488 | HEALTH PARTNERS (01) | PA |
5810126 | AETNA HMO (01) | PA |
I10181 | (02) | PA |
P00385401 | RAILROAD MEDICARE (01) | PA |