Individual
ROBERT WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3425 MERLIN DR, SUITE 200, IDAHO FALLS, ID 83404-7430
(208) 528-6653
Mailing address
1240 GRASSLAND DR, IDAHO FALLS, ID 83404-8293
(208) 528-0316
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-456
ID
Other
Enumeration date
06/04/2007
Last updated
03/04/2015
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