Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 4050 | TN |
NPI | 1518924042 |
---|---|
Provider Name | Dr. Robert S Wilroy |
First Address | Memphis, TN 38104-3600 |
Second Address | Memphis, TN 38104-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 19/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I378173 | MEDICARE ID (01) | TN |
3177240 | (05) | TN |
D32106 | (02) |