Individual
MARK L WILLATS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2 W 42ND ST, STE 2700, SCOTTSBLUFF, NE 69361-4669
(308) 632-3668
(308) 635-1355
Mailing address
2 W 42ND ST, STE 2700, SCOTTSBLUFF, NE 69361-4669
(308) 632-3668
(308) 635-1355
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
261
NE
213ES0103X
Foot & Ankle Surgery Podiatrist
261
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47081685307
—
NE
Enumeration date
07/31/2006
Last updated
06/08/2020
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