Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036053272 | IL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 036053272 | IL |
NPI | 1144270596 |
---|---|
Provider Name | Dr. Jerome J Epplin |
First Address | Litchfield, IL 62056-1778 |
Second Address | Litchfield, IL 62056-1778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036053272 | (05) | IL |
080022053 | RAILROAD MEDICARE (01) | IL |
C38061 | (02) | IL |