Provider Demographics
NPI:1538153127
Name:WILLIS, JAMES ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11971 HERITAGE OAK PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2461
Mailing Address - Country:US
Mailing Address - Phone:530-745-9615
Mailing Address - Fax:530-745-9610
Practice Address - Street 1:11971 HERITAGE OAK PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2461
Practice Address - Country:US
Practice Address - Phone:530-745-9615
Practice Address - Fax:530-745-9610
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37443207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028370Medicaid
CAA47088Medicare UPIN
CAGR0028370Medicaid