DR. FRED SPENCER WILLIS SR. (NPI# 1245441005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245441005 |
| Entity Type | Individual |
| Full Name | DR. FRED SPENCER WILLIS SR. |
| Credential | M.D. |
| Practice Address |
1560 Irving Pl Shreveport LA 71101-4604 |
| Mailing Address |
11245 Heritage Oaks Shreveport LA 71106-8386 |
| Practice Telephone | 3182121194 |
| Practice Fax Number | 3182121196 |
| Mailing Telephone | 3187978203 |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2015-02-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 009828 | LA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235131665 | Fred S Willis | Emergency Medicine | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2005-08-15 |
| Street Address |
1560 IRVING PL |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669028692 | Elizabeth Chesne | Physician Assistant | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2019-08-15 |
| 1972058170 | Diabetes Assessment and Management Center of Shreveport LLC | Dietitian, Registered | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2016-08-18 |
| 1417349101 | Barbin Lewis | Dietitian, Registered | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2015-03-04 |
| 1073950028 | Diabetes Assessment and Management Center of Shreveport, LLC | Clinic/Center | 1560 Irving Pl, Suite 501, Shreveport, LA 71101-4604 | 2013-05-31 |
| 1285881508 | Genesis Nephrology, LLC | Internal Medicine | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2008-08-19 |
| 1205047578 | William Lee Gibson Jr. | Family Medicine | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2007-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255988630 | Renee Jewitt | Case Manager/Care Coordinator | 1513 Line Avenue, Suite 225, Shreveport, LA 71101 | 2019-08-21 |
| 1942770094 | Bessie Larry | Case Manager/Care Coordinator | 1513 Line Av, 222, Shreveport, LA 71101 | 2018-12-03 |
| 1750875944 | Jarvis Decarleonne Larry | Community Health Worker | 1513 Line Ave # 222, Shreveport, LA 71101 | 2018-06-20 |
| 1871083485 | Kimberly B. Mcclelland, Lcsw | Counselor | 820 Jordan St. Ste 510w, Shreveport, LA 71101 | 2018-05-18 |
| 1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
| 1528572955 | Spencer Ron Floyd | Counselor | 1717 Marshall Street, Shreveport, LA 71101 | 2017-11-21 |
| 1578088076 | Brittany Morris | Case Manager/Care Coordinator | 1835 Spring Street Annex Building, Shreveport, LA 71101 | 2017-08-07 |
| 1275058794 | Diane Williams | Case Manager/Care Coordinator | 217 Jones St Apt 510, Shreveport, LA 71101 | 2017-08-04 |
| 1386195972 | Jakeya Woodbury | Counselor | 453 Stoner Ave, Shreveport, LA 71101 | 2016-10-18 |
| 1922459643 | Arlene Huling | Counselor | 449 Egan Street, Shreveport, LA 71101 | 2016-06-23 |
| Find all providers in zip 71101 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922621390 | Partners In Primary Care La PC | Family Medicine | 7551 Youree Dr Ste 11, Shreveport, LA 71105-5533 | 2020-05-20 |
| 1528609104 | Spectra Family Clinic, LLC | Family Medicine | 9300 Mansfield Rd Ste 209, Shreveport, LA 71118-3138 | 2019-10-04 |
| 1922502327 | Courtney Morgan | Family Medicine | 723 Milam St, Shreveport, LA 71101-3507 | 2018-03-20 |
| 1174973317 | Patrick Michael Fitz-gerald | Family Medicine | 731 Coachlight Rd, Shreveport, LA 71106-7205 | 2016-06-19 |
| 1437446341 | Samreena N Sara | Family Medicine | 8835 Line Ave Ste 400a, Shreveport, LA 71106-6722 | 2011-06-30 |
| 1932490554 | Michael Thomas Kitchell | Family Medicine | 1666 E Bert Koun Loop Ste 105, Shreveport, LA 71105-5718 | 2011-04-30 |
| 1831402254 | David J. Colvin Md LLC | Family Medicine | 148 Waters Edge Dr, Shreveport, LA 71106-7774 | 2010-07-15 |
| 1952628802 | Tri Pham | Family Medicine | 133 Charles Ave, Shreveport, LA 71105-3719 | 2010-04-30 |
| 1669799524 | Stephanie James | Family Medicine | 2120 Bert Kouns Industrial Loop Ste M, Shreveport, LA 71118-3355 | 2010-04-30 |
| 1205062965 | Charles Henry Nash | Family Medicine | 5935 Gilbert Dr, Shreveport, LA 71106-2315 | 2009-06-08 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
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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.