Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 2006006896 | MO |
NPI | 1386679298 |
---|---|
Provider Name | Dr. Gilbert Wilshire |
First Address | Columbia, MO 65201-8078 |
Second Address | Columbia, MO 65201-8078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 23/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F36365 | (02) | MO |