Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036-083720 | IL |
NPI | 1013017706 |
---|---|
Provider Name | Dr. Thomas Neil Rooke |
First Address | Springfield, IL 62703-2403 |
Second Address | Springfield, IL 62703-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F34580 | (02) |