Individual
JASON WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 12TH AVE, NW, MERCY ARDMORE HOSPITAL WOUND CARE CENTER, ARDMORE, OK 73401
(580) 220-6290
Mailing address
PO BOX 848371, BOSTON, MA 02284-8371
(580) 920-9000
(580) 920-9159
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29655
OK
Other
Enumeration date
03/06/2007
Last updated
10/19/2015
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