Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 73008 | WI |
NPI | 1053792457 |
---|---|
Provider Name | Eric Whittington |
First Address | Knoxville, TN 37920-1511 |
Second Address | Madison, WI 53792-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 15/06/2020 |