Jeffrey Ryuta Willis, M.D., PHD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

A123650 Issued in CA

Practice address

4860 Y St Ste 2400
Sacramento, CA 95817-2307

Phone

(916) 734-6602

Fax

(916) 734-6602

NPI assigned

May 18, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427760000000",
    "number": "1023301330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 N CHARLES ST STE 203",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212045805",
            "telephone_number": "443-849-3760",
            "fax_number": "443-849-8138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4860 Y ST STE 2400",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172307",
            "telephone_number": "916-734-6602",
            "fax_number": "916-734-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JEFFREY",
        "middle_name": "RYUTA",
        "name_prefix": "Dr.",
        "credential": "M.D., PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-18",
        "last_updated": "2015-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "A123650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Britney Ann Willis, RADT SUBSTA
• Giovonni Willis
• Harrisha Marie Willis
• Jada Nicole Willis
• James Henry Willis, PH.D
• Lindsay Willis
• Madison Grace Willis
• Roger F Willis III, MA, OPT, SUD
• Sandra E Willis, MD
• Shawnna-Michaella Willis

• Student in an Organized Health Care Education/Training Program in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.