Provider Demographics
NPI:1760463756
Name:WILLETT, ROBERT E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:WILLETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD STE B222
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6700
Mailing Address - Country:US
Mailing Address - Phone:251-663-0663
Mailing Address - Fax:251-663-6468
Practice Address - Street 1:6701 AIRPORT BLVD STE B222
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6700
Practice Address - Country:US
Practice Address - Phone:251-663-0663
Practice Address - Fax:251-663-6468
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9525174400000X
ALMD.9525208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710048OtherUNITED HEALTHCARE
020000385OtherTRAVELERS RR MEDICARE
AL051007227OtherBC BS ALABAMA
MS00018702OtherMEDICAID OF MISSISSIPPI