Individual
DR. ROGER CECIL WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
790 E 5TH ST, COQUILLE, OR 97423-1755
(541) 396-7295
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD26451
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165031
—
OR
Enumeration date
05/05/2006
Last updated
10/04/2021
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