Individual
JOHN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 W STEVE OWENS BLVD, MIAMI, OK 74354-7629
(918) 542-2845
Mailing address
304 N MICKEY MANTLE BLVD, COMMERCE, OK 74339-1110
(918) 675-4100
(918) 675-4615
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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