Individual
LARRY GRANT WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1110 N LEE AVE, OKLAHOMA CITY, OK 73103-2612
(405) 230-9000
(405) 230-9443
Mailing address
PO BOX 268981, OKLAHOMA CITY, OK 73126-8981
(405) 230-9000
(405) 230-9375
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
10557
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
730714291-016
BCBS OF OKLAHOMA
OK
Enumeration date
07/12/2005
Last updated
07/08/2007
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