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Organization
WAYNE S WILLIS MD LLC
Active
Organization
WAYNE S WILLIS MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE S. WILLIS MD (PRESIDENT)
(850) 438-9755
Entity
Organization
Contact information
Practice address
3111 PEGGY BOND DR, PENSACOLA, FL 32504-5018
(850) 438-9755
(850) 438-0699
Mailing address
3111 PEGGY BOND DR, PENSACOLA, FL 32504-5018
(850) 438-9755
(850) 438-0699
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274727800
—
FL
01
—
98793
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/01/2006
Last updated
02/05/2013
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