Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4058A | WY |
NPI | 1003826389 |
---|---|
Provider Name | Dr. Lynn Perrins Eskelson |
First Address | Green River, WY 82935-5060 |
Second Address | Green River, WY 82935-5060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 17/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002667800 | (05) | ID |
E51065 | (02) | ID |