MEDICARE: GREGORY S WILLIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	MD2016-0015	NM
2	2471R0002X	Radiation Therapy Radiologic Technologist	MD28019	OR
3	2085R0001X	Radiation Oncology Physician	MD28019	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140838	OTHER	OR	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	033138015	OTHER	OR	REGENCE BCBS

General Provider Information

NPI Number	:	1417941600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY S WILLIS M.D.

Provider Business Mailing Address
First Line	:	6489 SW BORLAND RD
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-9798
Country	:	US
Telephone Number	:	503-692-4843
Fax Number	:	503-692-6543

Provider Business Practice Location Address
First Line	:	6489 SW BORLAND RD
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-9798
Country	:	US
Telephone Number	:	503-692-4843
Fax Number	:	503-692-6543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/31/2025

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Directions to “ GREGORY S WILLIS M.D.” Practice Location

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