Provider Demographics
NPI:1003340662
Name:WILLIS, ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4018 KING CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5521
Mailing Address - Country:US
Mailing Address - Phone:919-271-4394
Mailing Address - Fax:
Practice Address - Street 1:N2198 UNC HOSPITALS CB# 7010
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7220
Practice Address - Country:US
Practice Address - Phone:919-966-5136
Practice Address - Fax:919-974-4873
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2020-02126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics