Individual
MARSHALL F WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 N 2000 W, PLEASANT GROVE, UT 84062-4047
(801) 756-3511
(801) 756-1705
Mailing address
PREMIER FAMILY MEDICAL, 275 W 200 N, PLEASANT GROVE, UT 84062-4047
(801) 756-3511
(801) 756-1705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1650701205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0456
DESERET MUTUAL BENEFIT AS
UT
05
—
06409
—
UT
01
—
107006253101
SELECT HEALTH
UT
01
—
3213
PEHP
UT
01
—
87029387384062B006
TRICARE
UT
01
—
870293873W11
EMIA
UT
01
—
QMXAF02074
ALTIUS
UT
Enumeration date
08/28/2006
Last updated
05/21/2021
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