Provider Demographics
NPI:1972767358
Name:WILLIS, ALYSON BLAKE (DO)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:BLAKE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:535 NW 9TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1070
Mailing Address - Country:US
Mailing Address - Phone:405-272-8498
Mailing Address - Fax:405-272-8425
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1068
Practice Address - Country:US
Practice Address - Phone:405-272-8498
Practice Address - Fax:405-272-8425
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2020-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology