DEREK PAUL WILLE (NPI# 1649629965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649629965 |
| Entity Type | Individual |
| Full Name | DEREK PAUL WILLE |
| Credential | MD |
| Practice Address |
4403 Harrison Blvd Suite A-700 Ogden UT 84403-3271 |
| Practice Telephone | 8013875300 |
| Practice Fax Number | 8013875333 |
| Mailing Telephone | 8013875300 |
| Mailing Fax Number | 8013875333 |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2019-06-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MED-PHYS-LIC-707 | MT | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
4403 HARRISON BLVD SUITE A-700 |
| City | OGDEN |
| State | UT |
| Zip Code | 84403-3271 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518962794 | Fred George Seale Iv | Obstetrics & Gynecology | 4403 Harrison Blvd, Ste 4650, Ogden, UT 84403-3271 | 2005-06-15 |
| 1720502859 | Derek Smith | Physician Assistant | 4403 Harrison Blvd, Ogden, UT 84403-3271 | 2017-07-31 |
| 1245766393 | Jacob Saunders | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1043746191 | Haleigh Emerson | Family Medicine | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1457887507 | Madison Beatty | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403 | 2017-05-11 |
| 1669908711 | Spencer Ruben | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1376083147 | Linda Maria Jones | Nurse Practitioner | 4403 Harrison Blvd, Suite 3490, Ogden, UT 84403 | 2017-02-27 |
| 1114376431 | Jonas Legrand Peterson | Family Medicine | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2016-06-07 |
| 1467838086 | Brandy Millward | Social Worker | 4403 Harrison Blvd, Suite 3630, Ogden, UT 84403-3271 | 2015-08-05 |
| 1972987949 | Shelsea Oman | Registered Nurse | 4403 Harrison Blvd, Suite 3835, Ogden, UT 84403 | 2015-07-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744632 | Megan Louise Larkins | Specialist/Technologist | 4000 Brinker Ave. The Apartments., Apartment 15, Ogden, UT 84403 | 2020-09-11 |
| 1154959062 | Joshua Clifford Hansen | Student in an Organized Health Care Education/Training Program | 4403 Harrison Boulevard, Ste A700, Ogden, UT 84403 | 2020-03-28 |
| 1346895935 | Positional Release Therapy Institute LLC | Specialist/Technologist | 1702 E. 5600 S., Ogden, UT 84403 | 2019-08-09 |
| 1841842077 | Braken Wooden | Chiropractor | 1893 Skyline Dr., Suite 204, South Ogden, UT 84403 | 2019-07-09 |
| 1023670569 | Wasatch Advanced Dental Care LLC | Dentist | 3590 Harrison Blvd Suite #1, Ogden, UT 84403 | 2019-07-05 |
| 1194237636 | Marci Niemeyer | Physician Assistant | 5929 Fashion Point Dr Ste 101, South Ogden, UT 84403 | 2017-10-24 |
| 1578081949 | Stephanie Jensen | Specialist/Technologist | 1473 36th Street, Ogden, UT 84403 | 2017-09-06 |
| 1891213385 | Forrest Sutherland | Specialist/Technologist | 1075 E 41st St., Ogden, UT 84403 | 2017-09-05 |
| 1184159022 | Nicole Lee Van Tassell | In Home Supportive Care | 1496 East 5600 South, Unit 6, Ogden, UT 84403 | 2017-04-28 |
| 1265889166 | Modern Dental Professionals Ut, PC | Dentist | 5974 S. Fashion Pointe Drive, Suite 210, South Ogden, UT 84403 | 2016-05-20 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710366299 | Elise Brinson Fazio | Family Medicine | 4403 Harrison Blvd Ste 3630, Ogden, UT 84403-3287 | 2015-05-29 |
| 1689012080 | Dawn Marie Pruett | Family Medicine | 4782 Oxford Dr, Ogden, UT 84403-4253 | 2013-06-06 |
| 1275865388 | Nameer T Qader, Md PC | Family Medicine | 5495 S 500 E Ste 100, Ogden, UT 84405-7422 | 2010-02-01 |
| 1316122427 | Joseph W. Nelson | Family Medicine | 2265 Fillmore Ave, Ogden, UT 84401-2136 | 2008-01-08 |
| 1902940323 | Caleb Daniel Glawe | Family Medicine | 320 W Walnut St, Ogden, IA 50212-3060 | 2007-02-18 |
| 1134293772 | Robert L Adams | Family Medicine | 1355 Hinkley Dr, Ogden, UT 84401-3376 | 2006-11-17 |
| 1376613141 | Richard Charles Arbogast | Family Medicine | 269 W 3300s, Ogden, UT 84401 | 2006-11-09 |
| 1598861999 | Gary F Holland Md PC | Family Medicine | 5742 Adams Ave Pkwy, Ogden, UT 84405-7157 | 2006-09-15 |
| 1275509176 | Robert Nelson Bertoldo | Family Medicine | 4401 Harrison Blvd Ste 1885, Ogden, UT 84403-3195 | 2006-02-28 |
| 1669467544 | James Aaron Bledsoe | Family Medicine | 5740 Crestwood Dr, Ogden, UT 84405-4869 | 2005-09-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.