Individual
JEFFREY A WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
30 HAGEN DR, SUITE 100, ROCHESTER, NY 14625-2658
(585) 338-2700
Mailing address
30 HAGEN DR, SUITE 100, ROCHESTER, NY 14625-2658
(585) 338-2700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
010727
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000929329001
HEALTHNOW
—
01
—
929329001
COMMUNITY BLUE
—
01
—
PA0498
PREFERRED CARE
—
01
—
PO19010727
BLUE CHOICE
—
Enumeration date
10/19/2006
Last updated
04/30/2021
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