Provider Demographics
NPI:1902042278
Name:MARTIN, WILLIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:135 WOODRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2294
Mailing Address - Country:US
Mailing Address - Phone:252-281-2567
Mailing Address - Fax:252-200-4473
Practice Address - Street 1:135 WOODRIDGE CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2294
Practice Address - Country:US
Practice Address - Phone:252-903-1372
Practice Address - Fax:252-200-4473
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2024-02-20
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Provider Licenses
StateLicense IDTaxonomies
NC19371207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC80976Medicare UPIN