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General NPI Number Information
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NPI Number | 1417941600
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Entity Type | Individual
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Provider Name | GREGORY S WILLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 6489 SW BORLAND RD
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City | TUALATIN
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State | OR
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Zip | 97062-9798
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Country | US
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Telephone | 503-692-4843
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Fax | 503-692-6543
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Provider Business Mailing Address
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Address Line | 6489 SW BORLAND RD
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City | TUALATIN
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State | OR
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Zip | 97062-9798
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Country | US
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Telephone | 503-692-4843
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Fax | 503-692-6543
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD2016-0015
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2471R0002X
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Taxonomy Name | Radiation Therapy Radiologic Technologist
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License Number | MD28019
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD28019
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License Number State | OR
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