Individual
WILLIS H. KEPHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4705 MONTGOMERY BLVD NE, STE 301, ALBUQUERQUE, NM 87109-1226
(505) 727-4500
(505) 727-4505
Mailing address
6100 PAN AMERICAN EAST FWY NE, STE 100, ALBUQUERQUE, NM 87109-3427
(505) 727-4500
(505) 727-4505
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
81-243
NM
207VG0400X
Gynecology Physician
2000165660
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010568509
—
MO
05
—
100188410A
—
OK
05
—
100327540B
—
KS
05
—
205083603
—
MO
05
—
32771
—
NM
05
—
540568508
—
MO
05
—
595956103
—
MO
05
—
595956202
—
MO
05
—
595956400
—
MO
05
—
595985805
—
MO
05
—
599225901
—
MO
05
—
90036022
—
KS
Enumeration date
06/24/2006
Last updated
08/10/2015
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