| Doctor Name: | MARK L WILLATS |
| NPI Number: | 1174539555 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 261 |
| Business Practice Address: | 2 W 42nd St Ste 2700 Scottsbluff, NE - 693614669 |
| Business Phone Number: | 3086323668 |
| Business Fax Number: | 3086351355 |
| Mailing Address: | 2 W 42nd St, Ste 2700 SCOTTSBLUFF |
| State: | NE |
| Postal Code: | 693614669 |
| Phone Number: | 3086323668 |
| Fax Number: | 3086351355 |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 11/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 261 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |