Randy David Willis, DO is a
Family Medicine physician based in Mt. Dora, Florida. Randy David Willis is licensed to practice in Florida (license number OS9622) and his current practice location is 19015 U.s. Highway 441, Mt. Dora, Florida. He can be reached at his office (for appointments etc.) via phone at
(352) 383-6479.
NPI number for Randy David Willis is 1689885550 and his current mailing address is 11550 University Blvd, Orlando, Florida. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1689885550.
Physician's Profile
| Full Name | Randy David Willis |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 19015 U.s. Highway 441, Mt. Dora, Florida |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1689885550
- Provider Enumeration Date: 05/24/2007
- Last Update Date: 03/31/2016
Medical Identifiers
Medical identifiers for Randy David Willis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1689885550 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | OS9622 (Florida) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Randy David Willis is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Randy David Willis, DO
11550 University Blvd,
Orlando, FL 32817-2100
Ph: (407) 384-0080 | Randy David Willis, DO
19015 U.s. Highway 441,
Mt. Dora, FL 32757
Ph: (352) 383-6479 |
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