Provider Demographics
NPI:1235106543
Name:CHESTER, WILLIE J (DO)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:J
Last Name:CHESTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-3328
Mailing Address - Country:US
Mailing Address - Phone:334-420-5038
Mailing Address - Fax:334-420-0158
Practice Address - Street 1:4452 US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-3328
Practice Address - Country:US
Practice Address - Phone:334-420-5001
Practice Address - Fax:334-293-6640
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9069Medicaid
D32803Medicare UPIN
AL9069Medicaid