| Doctor Name: | DR. JEFFREY RYUTA WILLIS |
| NPI Number: | 1023301330 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., PHD |
| License Number: | |
| Business Practice Address: | 4860 Y St Ste 2400 Sacramento, CA - 958172307 |
| Business Phone Number: | 9167346602 |
| Business Fax Number: | 9167346602 |
| Mailing Address: | 6565 N Charles St Ste 203, BALTIMORE |
| State: | MD |
| Postal Code: | 212045805 |
| Phone Number: | 4438493760 |
| Fax Number: | 4438498138 |
| NPI Enumeration Date: | 05/18/2011 |
| NPI Last Update Date: | 03/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |