Basic Information
| Provider Information | |||||||||
| NPI: | 1275525545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | ARNOLD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 85836 | GA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | TL6077 | WY | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD9513 | DC | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | D0020464 | MD | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | LT4196 | NH | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1095850 | 01 | CIGNA | OTHER | 028055 | 01 | JOHN HOPKINS | OTHER | 1901104 | 01 | UNITED HEALTHCARE AMERICHOICE | OTHER | P00439848 | 01 | RAILROAD MEDICARE | OTHER | 023376900 | 05 | DC | MEDICAID | 028055 | 01 | PRIORITY PARTNERS | OTHER | 1467393 | 01 | AETNA HMO | OTHER | 35301905 | 01 | BCBS MD | OTHER | 57620005 | 01 | BCBS DC | OTHER | 4053748 | 01 | AETNA PPO | OTHER | 35301902 | 01 | BCBS MD | OTHER | 45428 | 01 | OPTIMUM CHOICE | OTHER | 432105237 | 01 | BRAVO HEALTH | OTHER |