Individual
JOHN A WILLIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 N STREET EXT, HYANNIS, MA 02601-3825
(508) 775-8282
(508) 771-1496
Mailing address
130 N STREET EXT, HYANNIS, MA 02601-3825
(508) 775-8282
(508) 771-1496
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
160529
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0900676
UNITED HEALTH
—
01
—
160529
TUFTS
—
05
—
2065118
—
MA
01
—
2431064
AETNA
—
01
—
5061233001
CIGNA
—
01
—
68934
PILGRIM
—
05
—
9773983
—
MA
01
—
J21143
BCBS
—
Enumeration date
08/30/2005
Last updated
07/09/2007
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