Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 37014 | MO |
NPI | 1104995661 |
---|---|
Provider Name | Dr. James W Willoughby II |
First Address | Liberty, MO 64068-2323 |
Second Address | Liberty, MO 64068-2323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 27/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18256037 | BCBS OF KANSAS CITY (01) | MO |
F25891 | (02) | MO |