Healthcare Provider Details

I. General information

NPI: 1184574501
Provider Name (Legal Business Name): WILLIS PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 S COLLEGE DR STE 302
MURRAY UT
84123-2991
US

IV. Provider business mailing address

630 PETER JEFFERSON PKWY STE 100
CHARLOTTESVILLE VA
22911-4624
US

V. Phone/Fax

Practice location:
  • Phone: 801-293-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RHETT WILLIS
Title or Position: OWNER
Credential: MD
Phone: 801-293-8100