Active NPI
D Keith Willmore, MD
- General Practice Physician
- Provo, UT
National Provider Identifier
1861676066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 263411-1205
- Practice address
- 1750 N Wymount Terrace Dr
Provo, UT 84601-4800 - Phone
- (801) 422-2771
- Fax
- (801) 422-0761
- NPI assigned
- Dec 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 263411-1205 | UT | Primary |
Addresses
Primary practice location
1750 N Wymount Terrace Dr
Provo, UT 84601-4800
Mailing address
1750 N Wymount Terrace Dr
Provo, UT 84601-4800
Phone (801) 422-2771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 263411-1205 | UT | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brigham Young University | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1861676066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 N WYMOUNT TERRACE DR",
"city": "PROVO",
"state": "UT",
"postal_code": "846014800",
"telephone_number": "801-422-2771",
"fax_number": "801-422-0761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 N WYMOUNT TERRACE DR",
"city": "PROVO",
"state": "UT",
"postal_code": "846014800",
"telephone_number": "801-422-2771",
"fax_number": "801-422-0761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLMORE",
"first_name": "D",
"middle_name": "KEITH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-24",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "UT",
"license": "263411-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.