MEDICARE: DR. WILLIS Y WU M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	14363	NV

General Provider Information

NPI Number	:	1669633046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIS Y WU M.D.

Provider Business Mailing Address
First Line	:	9920 W CHEYENNE AVE
Second Line	:	110
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7725
Country	:	US
Telephone Number	:	702-684-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	9920 W CHEYENNE AVE
Second Line	:	110
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7725
Country	:	US
Telephone Number	:	702-684-7246
Fax Number	:

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	03/09/2017

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