Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0190016639 | IL |
NPI | 1114043312 |
---|---|
Provider Name | Dr. James Walter Mcgough |
First Address | Aurora, IL 60506-1465 |
Second Address | Aurora, IL 60506-1465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T38142 | (02) | IL |