Chad D. Willis, D.O., P.C.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

4875 Issued in OK

Legal business name

CHAD D. WILLIS, D.O., P.C.

Practice address

5402 SW Lee Blvd
Lawton, OK 73505-9521

Phone

(580) 531-0022

Fax

(580) 531-0026

NPI assigned

Jun 16, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Therese A Simon

Title

Crentialing

Phone

(580) 531-0022

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1174844864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5402 SW LEE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735059521",
            "telephone_number": "580-531-0022",
            "fax_number": "580-531-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5402 SW LEE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735059521",
            "telephone_number": "580-531-0022",
            "fax_number": "580-531-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAD D. WILLIS, D.O., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "THERESE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CRENTIALING",
        "authorized_official_telephone_number": "580-531-0022",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "OK",
            "license": "4875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Lawton, OK
• Providers in Lawton, OK by specialty
• Otolaryngology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; 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.