Healthcare Provider Details

I. General information

NPI: 1831397124
Provider Name (Legal Business Name): MARK BILLY WILLITS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2007
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE SUITE 420
TULSA OK
74136-7823
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1400
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-8810
  • Fax: 918-502-8815
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number35.090321
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: