Individual
DONALD WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
313 W COUNTRY CLUB RD, SUITE # 9, ROSWELL, NM 88201-5804
(505) 624-1333
(505) 234-1362
Mailing address
1306 N GUADALUPE ST, CARLSBAD, NM 88220-4676
(505) 887-8887
(505) 234-1362
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A-822-85
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40790
—
NM
Enumeration date
04/25/2006
Last updated
07/08/2007
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