Individual
DR. KENNETH DEAN WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3007 MEMORIAL PKWY SW, HUNTSVILLE, AL 35801-5393
(256) 882-2003
(256) 705-4630
Mailing address
PO BOX 18084, HUNTSVILLE, AL 35804-8084
(256) 882-2003
(256) 705-4630
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
12320
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529908240
—
AL
Enumeration date
11/21/2006
Last updated
01/06/2017
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