Paul Michael Willette, M.D.
Individual provider Active NPI Surgery Physician · Clayton, NM
NPI 1376532424 · NPPES record last updated Jan 22, 2015
Key facts
- NPI
- 1376532424
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 12443 (NH)
- Practice address
- 300 Wilson St
Clayton, NM 88415-3304 - Phone
- (575) 374-0021
- NPI assigned
- Oct 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12443 | NH | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Box Butte General Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 12443 | NH | Yes |
Addresses
Primary practice location
300 Wilson St
Clayton, NM 88415-3304
Mailing address
PO Box 545
Clayton, NM 88415-0545
Phone (575) 374-0021
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30204277 | Medicaid | NH |
Other providers in Clayton, NM
- Union County Medical Center Inc
- Mark Edward Van Wormer
- Emily P Weese
- Hannah Beck Wells
- Wellspring Mental Health Practice
- Quirina Lucy Wolfe
- Micah Wolffarth
- Megan Wood
- Jessica Wright
All providers in Clayton, NM · Surgery Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.