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General NPI Number Information
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NPI Number | 1194833475
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Entity Type | Individual
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Provider Name | MARSHALL F WILLIS MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 830 N 2000 W
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-4047
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Country | US
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Telephone | 801-756-3511
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Fax | 801-756-1705
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Provider Business Mailing Address
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Address Line | PREMIER FAMILY MEDICAL 275 W 200 N
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-4047
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Country | US
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Telephone | 801-756-3511
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Fax | 801-756-1705
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1650701205
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License Number State | UT
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