Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 36923 | CO |
NPI | 1063489326 |
---|---|
Provider Name | Dr. John M Wilhite |
First Address | Colorado Springs, CO 80918-7327 |
Second Address | Ft Carson, CO 80913-4603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 08/07/2007 |