Provider Demographics
NPI:1952389090
Name:WILLIS, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19436 HOWELL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6459
Mailing Address - Country:US
Mailing Address - Phone:315-786-2000
Mailing Address - Fax:315-786-2899
Practice Address - Street 1:19436 HOWELL DR
Practice Address - Street 2:SUITE A
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-6459
Practice Address - Country:US
Practice Address - Phone:315-786-2000
Practice Address - Fax:315-786-2899
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-05-06
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Provider Licenses
StateLicense IDTaxonomies
NY1570511207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0071292Medicaid
NY0071292Medicaid