Individual
JAMES O'BRYAN WILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3737 SOUTHERN BLVD, SUITE 2100, KETTERING, OH 45429-1225
(937) 433-5309
(937) 298-0287
Mailing address
3737 SOUTHERN BLVD STE 2100, KETTERING, OH 45429-1285
(937) 433-5309
(937) 298-0287
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50002155
OH
363AS0400X
Surgical Physician Assistant
Primary
2155
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
349758
ANTHEM
OH
01
—
P00182934
MEDICARE RAILROAD
OH
Enumeration date
08/11/2006
Last updated
11/13/2020
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