Individual
DR. JOHN KELVER WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2810 E CAUSEWAY APPROACH, MANDEVILLE, LA 70448-3502
(985) 875-2340
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
MD.04407R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125480
—
MS
05
—
1190951
—
LA
Enumeration date
07/17/2006
Last updated
12/27/2007
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