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Individual

JEFF R WILLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1930 W BROADWAY ST STE A, MISSOULA, MT 59808-1960
(406) 541-6844
(406) 541-6843
Mailing address
1930 W BROADWAY ST STE A, MISSOULA, MT 59808-1960
(406) 541-6844
(406) 541-6843

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101059226
VA
207RG0100X
Gastroenterology Physician
Primary
56022
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100012482
MEDICARE RR
VA
01
15750
OPTIMA
VA
01
1659563799
GROUP NPI
VA
01
327082
ANTHEM
VA
01
5426240
AETNA
VA
05
5825041
VA
05
8905530
NC
Enumeration date
06/15/2006
Last updated
10/07/2024
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