Provider Demographics
NPI:1770014516
Name:WILLMORE, JAMES THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:WILLMORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N GATEWAY DR STE 801
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9004
Mailing Address - Country:US
Mailing Address - Phone:435-787-1023
Mailing Address - Fax:
Practice Address - Street 1:435 N GATEWAY DR STE 801
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9004
Practice Address - Country:US
Practice Address - Phone:435-787-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT11690691-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program