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General NPI Number Information
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NPI Number | 1831194216
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Entity Type | Individual
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Provider Name | RUDOLPH E WILLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 355 CRAWFORD ST STE 300
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2819
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Country | US
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Telephone | 757-396-6333
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Fax | 757-396-6367
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Provider Business Mailing Address
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Address Line | 355 CRAWFORD ST STE 300
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2819
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Country | US
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Telephone | 757-396-6333
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Fax | 757-396-6367
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 0101233411
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License Number State | VA
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