David Willis DO PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS9622 Issued in FL

Legal business name

DAVID WILLIS DO PA

Practice address

919 Leather Fern Lane
Mims, FL 32754

Phone

(407) 421-3599

NPI assigned

May 24, 2007

Last updated

Sep 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Willis, D.O.

Title

Owner

Phone

(407) 421-3599

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1932310679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 LEATHER FERN LANE",
            "city": "MIMS",
            "state": "FL",
            "postal_code": "32754",
            "telephone_number": "407-421-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 LEATHER FERN LANE",
            "city": "MIMS",
            "state": "FL",
            "postal_code": "32754",
            "telephone_number": "407-421-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID WILLIS DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-421-3599",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Mims, FL
• Providers in Mims, 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 Sep 16, 2008; 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.