| Doctor Name: | DR. ROBERT L WILLIS |
| NPI Number: | 1073507182 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 10148 |
| Business Practice Address: | 201 S Carter St Carterville, MO - 648351451 |
| Business Phone Number: | 4176733843 |
| Business Fax Number: | 4176731160 |
| Mailing Address: | 201 S Carter St, CARTERVILLE |
| State: | MO |
| Postal Code: | 648351451 |
| Phone Number: | 4176733843 |
| Fax Number: | 4176731160 |
| NPI Enumeration Date: | 09/02/2005 |
| NPI Last Update Date: | 03/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/24/2006 |
| NPI Reactivation Date: | 04/06/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | 10148 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |