Active NPI
Fred Spencer Willis Sr., M.D.
- Family Medicine Physician
- Shreveport, LA
National Provider Identifier
1245441005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 009828
- Practice address
- 1560 Irving PL
Shreveport, LA 71101-4604 - Phone
- (318) 212-1194
- Fax
- (318) 212-1196
- NPI assigned
- May 24, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 009828 | LA | Primary |
Addresses
Primary practice location
1560 Irving PL
Shreveport, LA 71101-4604
Mailing address
11245 Heritage Oaks
Shreveport, LA 71106-8386
Phone (318) 797-8203
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 |
|---|---|---|---|
| 009828 | LA | MD | Family Medicine Physician |
| 9828 | LA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422835200000",
"number": "1245441005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11245 HERITAGE OAKS",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711068386",
"telephone_number": "318-797-8203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1560 IRVING PL",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014604",
"telephone_number": "318-212-1194",
"fax_number": "318-212-1196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "FRED",
"middle_name": "SPENCER",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2015-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "LA",
"license": "009828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.