Healthcare Provider Details

I. General information

NPI: 1578675443
Provider Name (Legal Business Name): SILAS ANGIER WILLS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N 18TH AVE STE 2
POCATELLO ID
83201-3324
US

IV. Provider business mailing address

240 N 18TH AVE STE 2
POCATELLO ID
83201-3324
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-5550
  • Fax: 208-232-5553
Mailing address:
  • Phone: 208-232-5550
  • Fax: 208-232-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberM6899
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: