Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01020461A | IN |
NPI | 1013219435 |
---|---|
Provider Name | Dr. Walter William Jolly |
First Address | Carmel, IN 46032-8897 |
Second Address | Carmel, IN 46032-8897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2010 |
Last Update Date | 18/11/2010 |