Provider Demographics
NPI:1710390612
Name:WILLS, STEPHEN C (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:WILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7782
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:1000 LINCOLN ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3290
Practice Address - Country:US
Practice Address - Phone:970-542-4390
Practice Address - Fax:970-542-4913
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0058785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine