AUSTIN GLENN WILLIS (NPI# 1083034920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083034920 |
| Entity Type | Individual |
| Full Name | AUSTIN GLENN WILLIS |
| Credential | DO |
| Practice Address |
1100 Central Ave Se Albuquerque NM 87106-4930 |
| Mailing Address |
Po Box 26666 Phs Provider Enrollment Albuquerque NM 87125-6666 |
| Practice Telephone | 5058411063 |
| Mailing Telephone | (505) 923-6770 |
| Mailing Fax Number | 5059235354 |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2017-09-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | A-2075-17 | NM | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | BP1-0059381 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 32103778 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588145429 | Austin Tyler Willis | Dentist | 402 Carriage Dr, Beckley, WV 25801-2806 | 2018-08-28 |
| 1609375732 | Austin Willis | Behavior Technician | 90 Compark Rd Ste D, Centerville, OH 45459-4982 | 2018-02-05 |
| Street Address |
1100 CENTRAL AVE SE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87106-4930 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457354243 | Robert A Biazak | Anesthesiology | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2005-05-24 |
| 1043811045 | Nathan Michael Mabon | Registered Nurse | 1100 Central Ave Se, Albuquerque, NM 87106-4934 | 2020-11-05 |
| 1588274039 | Caryn Hong Thi Nguyen | Pharmacist | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2020-08-07 |
| 1396355996 | Hope Jessica Montoya | Internal Medicine | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2020-08-07 |
| 1326658030 | Chaniece Doyle | Pharmacist | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2020-08-06 |
| 1598375495 | Daniel Sanchez | Pharmacist | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2020-08-05 |
| 1215551478 | Yousuf Shakir | Pharmacist | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2020-06-03 |
| 1861037715 | Jeffrey Lillie | Nurse Anesthetist, Certified Registered | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2019-11-14 |
| 1396387502 | Justin Schmetterer | Pharmacist | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2019-10-09 |
| 1669023602 | Jalayne Faulhaber | Nurse Practitioner | 1100 Central Ave Se, Albuquerque, NM 87106-4930 | 2019-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679808 | Jorge Licano | Student in an Organized Health Care Education/Training Program | Unmh Hospital 2211 Lomas Blvd Ne, Albuquerque, NM 87106 | 2020-11-04 |
| 1730780032 | Joseph Sanchez | Student in an Organized Health Care Education/Training Program | (unmh Hospital 2211 Lomas Blvd Ne, Albuquerque, NM 87106 | 2020-11-03 |
| 1336746205 | Evan Laub | Pharmacist | 2950 Central Ave. Sw, Albuquerque, NM 87106 | 2020-10-05 |
| 1487203154 | Theresa Martinez | Technician | 5680 Avedon Dr. Se, Albuquerque, NM 87106 | 2019-09-05 |
| 1205300647 | Louis Mayer II | Specialist/Technologist | 1414 University Blvd Tow Diehm Athletic Facility, Albuquerque, NM 87106 | 2019-01-18 |
| 1235633355 | Terrena Grace Vigil Brady | Occupational Therapist | 1001 Yale Blvd, Albuquerque, NM 87106 | 2018-03-22 |
| 1205355195 | Yaritza Ruiz | Specialist/Technologist | 1200 Avenida Cesar Chavez, 231d, Albuquerque, NM 87106 | 2017-09-12 |
| 1457873382 | Cynthia Bluhm | Registered Nurse | 7600 Cedar St Se Ste 7600, Albuquerque, NM 87106 | 2017-07-12 |
| 1295265882 | Hallie Chancellor | Behavior Technician | 1801 Gibson Blvd Se Apt 1046, Albuquerque, NM 87106 | 2017-06-15 |
| 1780111757 | Jiana Hook | Physical Medicine & Rehabilitation | 1414 University Blvd. Se, Albuquerque, NM 87106 | 2017-05-22 |
| Find all providers in zip 87106 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851814784 | Ally Renee Funkhouser Dye | Pediatrics | 2130 Eubank Blvd Ne, Albuquerque, NM 87112 | 2017-07-23 |
| 1528417953 | Sofia Michelle Markee | Pediatrics | 1 University of New Mexico Pediatric Department, Albuquerque, NM 87131-0001 | 2016-06-07 |
| 1619363751 | Lauren N Gabreski | Pediatrics | Us Air Force, 377 Mdg/sghc, 2050a Second Street Se, Albuquerque, NM 87117-5522 | 2015-04-15 |
| 1174918197 | Ross Newman | Pediatrics | 2211 Lomas Blvd Ne # 3acc, Albuquerque, NM 87106-2719 | 2015-04-06 |
| 1942612650 | Amy M Rouse | Pediatrics | 933 Bradbury Dr Se Ste 222, Albuquerque, NM 87106 | 2014-05-29 |
| 1215362017 | Deborah Mcgrew Md LLC | Pediatrics | 1615 University Blvd Ne, Albuquerque, NM 87102-1717 | 2013-09-11 |
| 1477986065 | Gypsum Medical Associates of New Mexico, PC | Pediatrics | Building 9200, Area Y, Kirtland Air Force Base-east, Albuquerque, NM 87115 | 2013-08-19 |
| 1750653069 | Molina Healthcare of New Mexico | Pediatrics | 7317 Central Ne, Albuquerque, NM 87108-2015 | 2012-02-01 |
| 1720370612 | Alfonso Belmonte | Pediatrics | Unm Department of Pediatrics Msc10 5590, Albuquerque, NM 87131-0001 | 2011-05-10 |
| 1326288010 | Minh N. Ho | Pediatrics | 4701 Montgomery Boulevard Ne, Albuquerque, NM 87109 | 2009-02-20 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87106 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.