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General NPI Number Information
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NPI Number | 1184574501
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Entity Type | Organization
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Legal Business Name | WILLIS PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 5292 S COLLEGE DR STE 302
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City | MURRAY
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State | UT
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Zip | 84123-2991
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Country | US
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Telephone | 801-293-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 630 PETER JEFFERSON PKWY STE 100
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-4624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RHETT WILLIS
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Credential | MD
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Telephone | 801-293-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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