| Doctor Name: | DR. WILLIAM A WILLIS |
| NPI Number: | 1205875846 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 12280 |
| Business Practice Address: | 307 N Broadway St Poteau, OK - 749533355 |
| Business Phone Number: | 9186472349 |
| Business Fax Number: | 9186472359 |
| Mailing Address: | Po Box 459, POTEAU |
| State: | OK |
| Postal Code: | 749530459 |
| Phone Number: | 9186472349 |
| Fax Number: | 9186472359 |
| NPI Enumeration Date: | 06/06/2006 |
| NPI Last Update Date: | 01/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 12280 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |