| Doctor Name: | DR. SCOTT G WILLSON |
| NPI Number: | 1013136860 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 04-32856 |
| Business Practice Address: | 11879 W 112th St Suite 300 Overland Park, KS - 662102725 |
| Business Phone Number: | 9136533614 |
| Business Fax Number: | 9138391437 |
| Mailing Address: | 11879 W 112th St, Suite 300 OVERLAND PARK |
| State: | KS |
| Postal Code: | 66210 |
| Phone Number: | 9136533614 |
| Fax Number: | 9138391437 |
| NPI Enumeration Date: | 04/24/2007 |
| NPI Last Update Date: | 08/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 04-32856 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |