Individual
MATTHEW WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
FORT DEFIANCE PHS HOSPITAL, CORNER OF RT N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 885, FORT DEFIANCE, AZ 86504-0885
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
221827
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49030230
—
NM
05
—
964644
—
AZ
Enumeration date
11/03/2006
Last updated
07/08/2007
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