Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | IL |
NPI | 1063564938 |
---|---|
Provider Name | Dr. Richard William Alcorn |
First Address | Springfield, IL 62703-5508 |
Second Address | Springfield, IL 62703-5508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |