Healthcare Provider Details

I. General information

NPI: 1750782157
Provider Name (Legal Business Name): JOSEPH BENJAMIN WILLS PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19075 NW TANASBOURNE DR SUITE 200
HILLSBORO OR
97124-5860
US

IV. Provider business mailing address

19075 NW TANASBOURNE DR SUITE 200
HILLSBORO OR
97124-5860
US

V. Phone/Fax

Practice location:
  • Phone: 844-966-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA169587
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: