Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD208021 | OR |
N | 208800000X | Urologist | P3486 | TX |
N | 208800000X | Urologist | TRN10996 | FL |
NPI | 1023211547 |
---|---|
Provider Name | Dr. Daniel Levi Willis |
First Address | Bend, OR 97708-6048 |
Second Address | Bend, OR 97701-7691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
311365601 | (05) | TX |
8DQ392 | BCBS (01) | TX |