Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 200500347 | NC |
NPI | 1144285123 |
---|---|
Provider Name | Dr. Thomas Michael Wiley |
First Address | Hickory, NC 28602-4249 |
Second Address | Hickory, NC 28602-4249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 04/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141E1 | BCBS PROVIDER ID# (01) | NC |
5903019 | (05) | NC |
I47686 | (02) | NC |