Individual
KENT WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
830 N 2000 W, PLEASANT GROVE, UT 84062
(801) 756-3511
Mailing address
830 N 2000 W, PLEASANT GROVE, UT 84062-4047
(801) 756-3511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10701125-1204
UT
208M00000X
Hospitalist Physician
10701125-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/22/2015
Last updated
07/13/2018
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