Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036064974 | IL |
NPI | 1184684565 |
---|---|
Provider Name | Dr. David Mayor |
First Address | Dekalb, IL 60115-9602 |
Second Address | Dekalb, IL 60115-9602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 27/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036064974 | (05) | IL |
E24637 | (02) | IL |