Provider Demographics
NPI:1871689554
Name:WILLS, JASON C (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:WILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E
Mailing Address - Street 2:#220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 E 3900 S
Practice Address - Street 2:SUITE 360
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1348
Practice Address - Country:US
Practice Address - Phone:801-263-3041
Practice Address - Fax:801-263-8485
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4732889207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT47328891205001OtherBLUE CROSS BLUE SHIELD
UT47328891205001OtherHEALTHWISE
UT47328891205001OtherVALUE CARE
UT88770OtherPUBLIC EMPLOYEES
UT47328891205001OtherBLUE CROSS BLUE SHIELD
UT47328891205001OtherHEALTHWISE
UTG72642Medicare UPIN