Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 76-117 | NM |
NPI | 1033102488 |
---|---|
Provider Name | Dr. Willliam F Willis |
First Address | Albuquerque, NM 87122-1914 |
Second Address | Albuquerque, NM 87109-1533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 07/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D36042 | (02) | NM |