Healthcare Provider Details

I. General information

NPI: 1417941600
Provider Name (Legal Business Name): GREGORY S WILLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6489 SW BORLAND RD
TUALATIN OR
97062-9798
US

IV. Provider business mailing address

6489 SW BORLAND RD
TUALATIN OR
97062-9798
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-4843
  • Fax: 503-692-6543
Mailing address:
  • Phone: 503-692-4843
  • Fax: 503-692-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD2016-0015
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License NumberMD28019
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD28019
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: