Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-109650 | IL |
N | 111NI0900X | Internist | 036-109650 | IL |
Y | 207RG0100X | Gastroenterologist | 036-109650 | IL |
NPI | 1013023449 |
---|---|
Provider Name | Dr. Alexis Ayonote |
First Address | Mattoon, IL 61938-4693 |
Second Address | Mattoon, IL 61938-9258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 13/11/2018 |