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DAVID WILLIS, D.O., P.A. - Florida Company Profile

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Company Details

Entity Name: DAVID WILLIS, D.O., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 15 May 2007 (18 years ago)
Date of dissolution: 23 Sep 2011 (14 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2011 (14 years ago)
Document Number: P07000059408
FEI/EIN Number 260204946
Address: 919 LEATHER FERN LANE, MIMS, FL, 32754
Mail Address: 919 LEATHER FERN LANE, MIMS, FL, 32754
ZIP code: 32754
City: Mims
County: Brevard
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
WILLIS DAVID D Director 919 LEATHER FERN LANE, MIMS, FL, 32754
WILLIS DAVID D Agent 919 LEATHER FERN LANE, MIMS, FL, 32754

National Provider Identifier

NPI Number:
1932310679

Authorized Person:

Name:
DAVID WILLIS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2011-09-23 - -
CHANGE OF PRINCIPAL ADDRESS 2009-01-24 919 LEATHER FERN LANE, MIMS, FL 32754 -
CHANGE OF MAILING ADDRESS 2009-01-24 919 LEATHER FERN LANE, MIMS, FL 32754 -
REGISTERED AGENT ADDRESS CHANGED 2009-01-24 919 LEATHER FERN LANE, MIMS, FL 32754 -

Documents

Name Date
ANNUAL REPORT 2010-04-03
ANNUAL REPORT 2009-01-24
ANNUAL REPORT 2008-01-22
Domestic Profit 2007-05-15

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Date of last update: 03 Aug 2025

Sources: Florida Department of State