Active NPI
George Edward Willis, M.D.
- Internal Medicine Physician
- Miami, FL
National Provider Identifier
1053619973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME 45994
- Practice address
- 12251 SW 69TH CT
Miami, FL 33156-5425 - Phone
- (305) 663-1342
- NPI assigned
- Mar 1, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME 45994 | FL | Primary |
Addresses
Primary practice location
12251 SW 69TH CT
Miami, FL 33156-5425
Mailing address
12251 SW 69TH CT
Miami, FL 33156-5425
Phone (305) 663-1342
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ME 45994 | Other | FL | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 45994 | FL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1053619973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12251 SW 69TH CT",
"city": "MIAMI",
"state": "FL",
"postal_code": "331565425",
"telephone_number": "305-663-1342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12251 SW 69TH CT",
"city": "MIAMI",
"state": "FL",
"postal_code": "331565425",
"telephone_number": "305-663-1342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "GEORGE",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-01",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME 45994",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "ME 45994",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.