Willis, Matthew

Willis, Matthew is an individual health care provider with primary practice located at Fort Defiance Phs Hospital Corner Of Rt N12 And N7, Fort Defiance AZ 86504. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Willis, Matthew can be contacted via phone (928) 729-8000.

Contact Information

Primary practice address
Fort Defiance Phs Hospital Corner Of Rt N12 And N7 Fort Defiance AZ 86504
Phone: (928) 729-8000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 221827 Massachusetts

Profile Details

NPI number 1487733036
LBN Legal business name Willis, Matthew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487733036 NPPES
New Mexico MEDICAID 49030230
New Mexico MEDICAID 964644

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