Individual
DR. THOMAS M WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
23816
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01238161
—
CO
05
—
706179
—
AZ
05
—
U2721
—
NM
Enumeration date
10/14/2005
Last updated
11/14/2008
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