Individual
PAUL M WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
27 HECKEL RD, SUITE 213, MC KEES ROCKS, PA 15136-1616
(412) 771-2266
(412) 771-2443
Mailing address
PO BOX 240, INGOMAR, PA 15127-0240
(412) 771-2266
(412) 771-2443
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD070567L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018020950001
—
PA
01
—
0109675000
INDEPENDENCE BLUE SHIELD
PA
01
—
1512196
GATEWAY HEALTH PLAN
PA
01
—
359754
HIGHMARK BLUE SHIELD
PA
01
—
P00267349
RAILROAD MEDICARE
PA
Enumeration date
08/07/2006
Last updated
12/02/2013
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