Individual
SCOTT WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5301 S CONGRESS AVE, ATLANTIS, FL 33462-1149
(561) 965-7300
Mailing address
417 SW 5TH ST, FORT LAUDERDALE, FL 33315-1015
(561) 213-3482
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
E-12318
AR
207P00000X
Emergency Medicine Physician
Primary
ME 87703
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268162500
—
FL
01
—
37295
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/10/2006
Last updated
06/11/2023
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