Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 04-32856 | KS |
NPI | 1013136860 |
---|---|
Provider Name | Dr. Scott G Willson |
First Address | Overland Park, KS 66210 |
Second Address | Overland Park, KS 66210-2725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 06/08/2013 |