Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 10148 | MO |
NPI | 1073507182 |
---|---|
Provider Name | Dr. Robert L Willis |
First Address | Carterville, MO 64835-1451 |
Second Address | Carterville, MO 64835-1451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 05/03/2010 |