Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 04-44501 | KS |
NPI | 1972569382 |
---|---|
Provider Name | Dr. John A Billingsley III |
First Address | Wichita, KS 67206-3413 |
Second Address | Wichita, KS 67206-3413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 20/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127773001 | (05) | AR |
201327070A | (05) | KS |
G02593 | (02) | AR |