Individual
DR. JONATHAN RANDALL WILLMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
580 N CAMINO MERCADO STE 8, CASA GRANDE, AZ 85122-5757
(520) 381-0380
(520) 836-1826
Mailing address
PO BOX 10097, CASA GRANDE, AZ 85130-0020
(520) 381-0380
(520) 836-1826
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
006349
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006349
MEDICAL LICENSE
AZ
01
—
031815
MEDICARE
AZ
01
—
031916
MEDICARE
AZ
05
—
901786
—
AZ
01
—
Z165308
MEDICARE
AZ
01
—
ZFQ31815
MEDICARE
AZ
Enumeration date
04/05/2010
Last updated
12/02/2021
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