Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | IL |
NPI | 1689781569 |
---|---|
Provider Name | Dr. Deborah Wagner Pockross |
First Address | Elgin, IL 60123-4703 |
Second Address | Elgin, IL 60123-4703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I65013 | (02) | IL |