Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 16239 | KS |
NPI | 1417966680 |
---|---|
Provider Name | C Wilson Wesbrook |
First Address | Wichita, KS 67208-0035 |
Second Address | Wichita, KS 67208-3054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018804 | BCBS (01) | KS |
1001 | PHS (01) | KS |
12149416 | MULTIPLAN (01) | KS |
16930 | COVENTRY (01) | KS |
200162 | HPK (01) | KS |
E61206 | (02) |