Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 2004034152 | MO |
NPI | 1013936749 |
---|---|
Provider Name | Dr. Eric P. Guilliams |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 15/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209408608 | (05) | MO |
H62692 | (02) | MO |