Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036115858 | IL |
NPI | 1427004647 |
---|---|
Provider Name | Dr. William Lighthart |
First Address | Jackson, WY 83002-0490 |
Second Address | Jackson, WY 83001-8640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336221712 | 830322741 (01) | WY |
83-0322741 | 1336221712 (01) | WY |