Provider Demographics
NPI:1669633046
Name:WU, WILLIS Y (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:Y
Last Name:WU
Suffix:
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 1:9920 W CHEYENNE AVE
Mailing Address - Street 2:110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7725
Mailing Address - Country:US
Mailing Address - Phone:702-684-7246
Mailing Address - Fax:
Practice Address - Street 1:9920 W CHEYENNE AVE
Practice Address - Street 2:110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7725
Practice Address - Country:US
Practice Address - Phone:702-684-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14363207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine