MEDICARE: PAUL L. WILLIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	151956	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184614703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL L. WILLIS MD

Provider Business Mailing Address
First Line	:	8 WHITAKER LN
Second Line	:
City	:	GROTON
State	:	MA
Zip	:	01450-1986
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 WRIGHT ST
Second Line	:
City	:	PALMER
State	:	MA
Zip	:	01069-1138
Country	:	US
Telephone Number	:	413-283-7651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/02/2021

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Directions to “ PAUL L. WILLIS MD” Practice Location

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