Individual
KENT E. WILLYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12695 MCMANUS BLVD, BLDG 6, SUITE A, NEWPORT NEWS, VA 23602-4435
(757) 969-1755
(757) 969-1722
Mailing address
860 OMNI BLVD, SUITE 303, NEWPORT NEWS, VA 23606-4430
(757) 232-8777
(757) 232-8866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101102606
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080166573
RR/MEDICARE
—
05
—
5611679
—
VA
Enumeration date
11/04/2005
Last updated
01/27/2014
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