Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1820 | ME |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A5941 | CA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 60425 | MA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 1820 | ME |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A5941 | CA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 60425 | MA |
N | 2081P2900X | Pain Medicine | 1820 | ME |
N | 2081P2900X | Pain Medicine | 60425 | MA |
NPI | 1659324234 |
---|---|
Provider Name | Dr. J Wayne Dillard |
First Address | Oceanside, CA 92054-6203 |
Second Address | Oceanside, CA 92054-6203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 27/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432162000 | (05) | ME |
D99887 | (02) | MA |