Individual
DR. FRED SPENCER WILLIS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1560 IRVING PL, SHREVEPORT, LA 71101-4604
(318) 212-1194
(318) 212-1196
Mailing address
11245 HERITAGE OAKS, SHREVEPORT, LA 71106-8386
(318) 797-8203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
009828
LA
Other
Enumeration date
05/24/2007
Last updated
02/02/2015
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