Provider Demographics
NPI:1396369906
Name:WILLIS F GAFFNEY M.D. P.C.
Entity Type:Organization
Organization Name:WILLIS F GAFFNEY M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-831-9009
Mailing Address - Street 1:2939 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9285
Mailing Address - Country:US
Mailing Address - Phone:989-831-9009
Mailing Address - Fax:989-607-6875
Practice Address - Street 1:2939 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9285
Practice Address - Country:US
Practice Address - Phone:989-831-9009
Practice Address - Fax:989-607-6875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health