Individual
DR. MARK C WILLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 E MARSHALL ST, ORTHOPAEDIC SURGERY, RICHMOND, VA 23298-0510
(804) 828-7240
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101053689
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010093074 54158118
—
VA
Enumeration date
10/12/2006
Last updated
01/04/2011
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