Individual
DR. JOHN A. WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1538 KANAWHA BLVD E, CHARLESTON, WV 25311-2435
(304) 344-3457
(304) 344-3480
Mailing address
PO BOX 11137, CHARLESTON, WV 25339-1137
(304) 344-3457
(304) 344-3480
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
15995
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001325206
FREEDOM BLUE & MS BC BS
WV
05
—
0120054000
—
WV
01
—
0130753
UMWA
WV
01
—
020011800
FEDERAL BLACK LUNG
WV
05
—
0828199
—
OH
05
—
14175
—
WV
01
—
14193
CARELINK & CARELINK PEIA
WV
01
—
151237200
US DOL & US POSTAL COMP
WV
01
—
55-0516458
GROUP FEIN #
WV
01
—
550516458
ACORDIA NATIONAL PEIA
WV
05
—
550516458
—
WV
05
—
64942089
—
KY
01
—
E67388
BRICKSTREET INSURANCE
WV
Enumeration date
06/13/2005
Last updated
08/12/2024
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