Provider Demographics
NPI:1013136860
Name:WILLSON, SCOTT G (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:WILLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10000 COLLEGE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1435
Mailing Address - Country:US
Mailing Address - Phone:913-653-3614
Mailing Address - Fax:913-232-7742
Practice Address - Street 1:10000 COLLEGE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1435
Practice Address - Country:US
Practice Address - Phone:913-653-3614
Practice Address - Fax:913-232-7742
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-32856208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1417689670Medicaid