Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101035944 | VA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 0101035944 | VA |
NPI | 1194894733 |
---|---|
Provider Name | Douglas F. Willson |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 07/08/2013 |