Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2006033639 | MO |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 4875 | OK |
NPI | 1750432043 |
---|---|
Provider Name | Dr. Chad D Willis |
First Address | Oklahoma City, OK 73125-8884 |
Second Address | Shawnee, OK 74804-9625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 11/11/2016 |