Provider Demographics
NPI:1538229018
Name:WILLETTS, PHILO F JR (MD)
Entity type:Individual
Prefix:
First Name:PHILO
Middle Name:F
Last Name:WILLETTS
Suffix:JR
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 1:37 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-3113
Mailing Address - Country:US
Mailing Address - Phone:401-596-7762
Mailing Address - Fax:401-596-6165
Practice Address - Street 1:37 EAST AVE
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3113
Practice Address - Country:US
Practice Address - Phone:401-596-7762
Practice Address - Fax:401-596-6165
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05339207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery