MEDICARE: DAVID WILLIS DO PA

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	207Q00000X	Family Medicine Physician	OS9622	FL

General Provider Information

NPI Number	:	1932310679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID WILLIS DO PA

Provider Business Mailing Address
First Line	:	919 LEATHER FERN LANE
Second Line	:
City	:	MIMS
State	:	FL
Zip	:	32754
Country	:	US
Telephone Number	:	407-421-3599
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 LEATHER FERN LANE
Second Line	:
City	:	MIMS
State	:	FL
Zip	:	32754
Country	:	US
Telephone Number	:	407-421-3599
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID WILLIS
Credential	:	D.O.
Telephone Number	:	407-421-3599

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	09/16/2008

Similar Medicare Providers

1760445811 — MRS. DEBRA LYNN BAKER
Practice Location Address:

4255 DIXIE WAY
MIMS, FL
32754-5150

Practice Phone: 321-267-7897
Practice Fax:

1689725913 — MS. BRENDA LEE STACK LMHC, CAP, NCC
Practice Location Address:

3302 GREEN ST
MIMS, FL
32754-3813

Practice Phone: 321-268-8828
Practice Fax: 321-567-0888

1740403880 — BARBARA THORNE
Practice Location Address:

2540 LEE RD
MIMS, FL
32754-5429

Practice Phone: 321-264-1964
Practice Fax:

1649476110 — DR. JAMES THOMAS NICHOLS III MD
Practice Location Address:

3635 PENNSYLVANIA AVE
MIMS, FL
32754-5114

Practice Phone: 321-289-2204
Practice Fax: 405-844-1794

1881885242 — FRANCIS HEALTHCARE CENTER LLC
Practice Location Address:

2448 US HIGHWAY 1
MIMS, FL
32754-3854

Practice Phone: 321-267-7423
Practice Fax: 321-264-2061

1861672883 — MS. AMY L SADLER
Practice Location Address:

4021 HOLDER PARK DR
MIMS, FL
32754-2510

Practice Phone: 321-264-4214
Practice Fax: 321-264-4214

Directions to “DAVID WILLIS DO PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.