Provider Demographics
NPI:1558789495
Name:WILLCOLL, LLC
Entity Type:Organization
Organization Name:WILLCOLL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:720-985-5899
Mailing Address - Street 1:9695 S YOSEMITE ST
Mailing Address - Street 2:#377
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2888
Mailing Address - Country:US
Mailing Address - Phone:303-814-1340
Mailing Address - Fax:303-814-1134
Practice Address - Street 1:9695 S YOSEMITE ST
Practice Address - Street 2:#377
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2888
Practice Address - Country:US
Practice Address - Phone:303-814-1340
Practice Address - Fax:303-814-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201411045852084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty