Healthcare Provider Details

I. General information

NPI: 1912964966
Provider Name (Legal Business Name): VOLNEY L WILLETT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 7TH ST W SUITE LL-50
DICKINSON ND
58601-4335
US

IV. Provider business mailing address

30 7TH ST W STE LL-50
DICKINSON ND
58601-4335
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-6974
  • Fax:
Mailing address:
  • Phone: 701-483-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-11545
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14301
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: