Individual
RUDOLPH E WILLIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
355 CRAWFORD ST, STE 300, PORTSMOUTH, VA 23704-2819
(757) 396-6333
(757) 396-6367
Mailing address
355 CRAWFORD ST, STE 300, PORTSMOUTH, VA 23704-2819
(757) 396-6333
(757) 396-6367
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
0101233411
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
374935
MAMSI/MDIPA
VA
01
—
437204
ANTHEM BCBS
VA
01
—
59557
OPTIMA HEALTH PLAN
VA
01
—
89067J2
NC MEDICAID
NC
01
—
P00013926
RAILROAD MEDICARE
VA
Enumeration date
06/14/2005
Last updated
07/09/2007
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