Larry Grant Willis, MD

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

10557 Issued in OK

Practice address

1110 N Lee Ave
Oklahoma City, OK 73103-2612

Phone

(405) 230-9000

Fax

(405) 230-9443

NPI assigned

Jul 12, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• McBride Clinic Orthopedic Hospital, LLC

  • Orthopaedic Surgery Physician
  • Oklahoma City, OK
  • NPI 1659413649

  Rheumatology

  Medicare reassignment NPD
• McBride Clinic Inc

  • Orthopaedic Surgery Physician
  • Oklahoma City, OK
  • NPI 1053319889

  Rheumatology

  NPD (past)

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952309155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268981",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268981",
            "telephone_number": "405-230-9000",
            "fax_number": "405-230-9375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N LEE AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731032612",
            "telephone_number": "405-230-9000",
            "fax_number": "405-230-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "LARRY",
        "middle_name": "GRANT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "OK",
            "license": "10557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF OKLAHOMA",
            "identifier": "730714291-016",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gennice Jenail Willis
• Guy Rance Willis, LCSW
• Heather Lynette Willis
• Kanisha Nicole Willis
• Kennyon Glenn Willis
• Logan David Willis
• Moriah Willis, PHARMD
• Nakiah Willis
• Paige Willis, CRNA
• Shawndrea Nicole Willis, BS IN MATH

• Rheumatology Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Rheumatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.