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General NPI Number Information
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NPI Number | 1538229018
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Entity Type | Individual
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Provider Name | PHILO F WILLETTS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 37 EAST AVE
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City | WESTERLY
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State | RI
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Zip | 02891-3113
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Country | US
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Telephone | 401-596-7762
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Fax | 401-596-6165
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Provider Business Mailing Address
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Address Line | 37 EAST AVE
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City | WESTERLY
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State | RI
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Zip | 02891-3113
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Country | US
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Telephone | 401-596-7762
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Fax | 401-596-6165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD05339
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License Number State | RI
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