Individual
DR. WILLARD DERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 FOOTHILL BLVD, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
Mailing address
15 N 2030 E, ROOM 2160A, SALT LAKE CITY, UT 84112-5339
(801) 585-2516
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01038107A
IN
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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