Individual
DR. KEVIN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
99 HIGHWAY 37, TOMS RIVER, NJ 08755-6423
(732) 557-8051
(732) 557-2064
Mailing address
2501 OREGON PIKE, SUITE 101, LANCASTER, PA 17601-4890
(717) 293-3223
(717) 390-2455
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA07932100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CF1652
RAILROAD MEDICARE
NJ
Enumeration date
10/05/2005
Last updated
11/21/2007
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