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General NPI Number Information
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NPI Number | 1922509074
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Entity Type | Individual
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Provider Name | CHRISTOPHER D WILLIS DO
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Gender | Male
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 4430 MISSOURI AVENUE ATTN: MCXP-DQS-CR
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City | FORT LEONARD WOOD
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State | MO
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Zip | 65473
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Country | US
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Telephone | 573-596-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 4430 MISSOURI AVENUE ATTN: MCXP-DQS-CR
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City | FORT LEONARD WOOD
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State | MO
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Zip | 65473
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Country | US
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Telephone |
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OP61587191
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 8775
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 011285
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E-16311
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2019037704
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License Number State | MO
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