Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 16135 | MN |
NPI | 1154578912 |
---|---|
Provider Name | Dr. John Callaway Wiltsie |
First Address | Rochester, MN 55901-3423 |
Second Address | Rochester, MN 55901-3423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2008 |
Last Update Date | 24/08/2008 |