Provider Demographics
NPI:1215902473
Name:PAUL, WILLIS R III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:R
Last Name:PAUL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3155
Mailing Address - Fax:412-359-3483
Practice Address - Street 1:4121 MONROEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2607
Practice Address - Country:US
Practice Address - Phone:877-257-6272
Practice Address - Fax:412-343-3769
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-11-19
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Provider Licenses
StateLicense IDTaxonomies
PARN252958L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001942022Medicaid
PAR78662Medicare UPIN