Davis, Willie Bob

Davis, Willie Bob is an individual health care provider with primary practice located at 20333 W 151St St , Olathe KS 66061-5350. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Davis, Willie Bob can be contacted via phone (913) 791-4408.

Contact Information

Primary practice address
20333 W 151St St Olathe KS 66061-5350
Phone: (913) 791-4408
Fax: (913) 791-4438
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X KS 04-17213 Kansas
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MO R5059 Missouri
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X R5059 Missouri
Allopathic & Osteopathic Physicians / General Practice 208D00000X 04-17213 Kansas
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 04-17213 Kansas

Profile Details

NPI number 1659376952
LBN Legal business name Davis, Willie Bob
Credentials Medical Examiner (ME)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2005
Last updated Apr 19th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659376952 NPPES
Missouri MEDICAID 201018322
Missouri MEDICAID 10001780C

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