Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 036137877 | IL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 036.137877 | IL |
N | 207NS0135X | Procedural Dermatology | 036.137877 | IL |
NPI | 1184919508 |
---|---|
Provider Name | Dr. James Lassiter Quertermous |
First Address | Barrington, IL 60011-3376 |
Second Address | Hoffman Estates, IL 60192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 01/10/2020 |