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General NPI Number Information
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NPI Number | 1912111097
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Entity Type | Individual
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Provider Name | ERICK J WILLIS MD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 2828 FIRST AVENUE SUITE 305
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City | HUNTINGTON
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State | WV
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Zip | 25702
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Country | US
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Telephone | 304-399-7565
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Fax | 304-399-7568
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Provider Business Mailing Address
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Address Line | PO BOX 4190
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-4190
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Country | US
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Telephone | 304-399-4405
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Fax | 304-399-2526
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 99999
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 23279
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License Number State | WV
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