Provider Demographics
NPI:1053497347
Name:WILLSEN, JOHN JULIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JULIUS
Last Name:WILLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1199 DELBON AVE
Mailing Address - Street 2:SUITE2
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2015
Mailing Address - Country:US
Mailing Address - Phone:209-668-3063
Mailing Address - Fax:209-668-4992
Practice Address - Street 1:1199 DELBON AVE
Practice Address - Street 2:SUITE2
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2015
Practice Address - Country:US
Practice Address - Phone:209-668-3063
Practice Address - Fax:209-668-4992
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG36877207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46847Medicare UPIN
00G368770Medicare ID - Type Unspecified