Provider Demographics
NPI:1750782157
Name:WILLS, JOSEPH BENJAMIN (PAC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:WILLS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19075 NW TANASBOURNE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19075 NW TANASBOURNE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5860
Practice Address - Country:US
Practice Address - Phone:844-966-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA169587363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical