Healthcare Provider Details

I. General information

NPI: 1922509074
Provider Name (Legal Business Name): CHRISTOPHER D WILLIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 N BUTTERFIELD RD
BOLIVAR MO
65613-3016
US

IV. Provider business mailing address

1240 N BUTTERFIELD RD
BOLIVAR MO
65613-3016
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-6021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-16311
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2019037704
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: