Individual
DR. WILLIAM A WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 WALL ST, POTEAU, OK 74953
(918) 839-2159
Mailing address
PO BOX 459, POTEAU, OK 74953-0459
(918) 839-2159
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
12280
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100117220A
—
OK
Enumeration date
06/06/2006
Last updated
06/04/2018
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