Individual
DR. DANIEL LEVI WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2090 NE WYATT CT STE 101, BEND, OR 97701-7691
(541) 382-6447
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900
(541) 706-2398
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD208021
OR
208800000X
Urology Physician
P3486
TX
208800000X
Urology Physician
TRN10996
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
311365601
—
TX
01
—
8DQ392
BCBS
TX
Enumeration date
06/11/2007
Last updated
01/24/2022
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