Randy David Willis, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS9622 Issued in FL

Practice address

19015 U.S. Highway 441
Mt. Dora, FL 32757

Phone

(352) 383-6479

NPI assigned

May 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459382400000",
    "number": "1689885550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11550 UNIVERSITY BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328172100",
            "telephone_number": "407-384-0080",
            "fax_number": "407-384-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19015 U.S. HIGHWAY 441",
            "city": "MT. DORA",
            "state": "FL",
            "postal_code": "32757",
            "telephone_number": "352-383-6479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "RANDY",
        "middle_name": "DAVID",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2016-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Williams
• Mikayla Williams
• Rachel Deborah Williams, LCSW
• Shihein Williams, PHARMD
• Tishara Williams
• Genester Sylvanna Wilson-King, MD FACOG
• Delania Tyevette Wilson
• Gabrielle Wilson
• Sheila Wilson
• Wise Chiropractic PA

• Family Medicine Physician in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; 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.