Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 21845 | TN |
NPI | 1003884073 |
---|---|
Provider Name | Dr. James Wike |
First Address | Knoxville, TN 37916-1809 |
Second Address | Knoxville, TN 37916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 12/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100028502 | PHP TENNCARE (01) | TN |
3065622 | (05) | TN |
4087755 | BLUE CROSS (01) | TN |
4087755 | BLUECARE (01) | TN |
F18364 | (02) | TN |
P00201593 | TRAVELERS MEDICARE (01) | TN |