Provider Demographics
NPI:1518914027
Name:WILLS, HEATH R (MD)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:R
Last Name:WILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30102
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0102
Mailing Address - Country:US
Mailing Address - Phone:702-948-8660
Mailing Address - Fax:702-483-6663
Practice Address - Street 1:6120 S FORT APACHE RD
Practice Address - Street 2:#150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6702
Practice Address - Country:US
Practice Address - Phone:702-948-8660
Practice Address - Fax:702-483-6663
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11442207L00000X, 208VP0014X, 207LP2900X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101309Medicare PIN
NVCS10702OtherPHARMACY
101309Medicare ID - Type Unspecified
BW9327873OtherDEA