Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | OS009400L | PA |
NPI | 1184605677 |
---|---|
Provider Name | Dr. Gregory S Willis |
First Address | Harrisburg, PA 17104-1612 |
Second Address | York, PA 17408-8815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 23/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001722360 | (05) | PA |
G83468 | (02) | PA |