Individual
DR. JERROLD C WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 GOOD SAMARITAN WAY, RADIOLOGY DEPT, MOUNT VERNON, IL 62864-2402
(618) 242-4600
Mailing address
PO BOX 2153 DEPT 20002, BIRMINGHAM, AL 35287-0001
(877) 465-0012
(303) 438-1351
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36057038
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057038-3
—
IL
01
—
300117217
RAILROAD GOOD SAM & ST MARY'S
IL
01
—
300119485
RAILROAD ST JOES/UTLAH
IL
Enumeration date
05/23/2006
Last updated
03/15/2021
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