Provider Demographics
NPI:1720031107
Name:WILLEY, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WILLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:WILLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19821 WETHERBY LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-9329
Mailing Address - Country:US
Mailing Address - Phone:813-388-9367
Mailing Address - Fax:813-388-9367
Practice Address - Street 1:19821 WETHERBY LN
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-9329
Practice Address - Country:US
Practice Address - Phone:813-388-9367
Practice Address - Fax:813-388-9367
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 55428207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063085300Medicaid
FL10284OtherBCBS
FL063085300Medicaid
FL10284OtherBCBS