Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | R-2272 | AR |
NPI | 1053320358 |
---|---|
Provider Name | Dr. Paul I Wills |
First Address | Fort Smith, AR 72913-3528 |
Second Address | Fort Smith, AR 72903-4067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 19/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17184 | (02) |