Basic Information
| Provider Information | |||||||||
| NPI: | 1982961181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | FIELDING | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 439 US HIGHWAY 158 W | ||||||||
| Address2: | |||||||||
| City: | YANCEYVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273798304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366949331 | ||||||||
| FaxNumber: | 3366947511 | ||||||||
| Practice Location | |||||||||
| Address1: | 439 US HIGHWAY 158 W | ||||||||
| Address2: | |||||||||
| City: | YANCEYVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273798304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366949331 | ||||||||
| FaxNumber: | 3366947511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2012 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2015-01110 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.