Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 036077281 | IL |
Y | 2086S0127X | Trauma Surgeon | 036077281 | IL |
N | 2086S0127X | Trauma Surgeon | 2004028848 | MO |
NPI | 1245279934 |
---|---|
Provider Name | Harry E Wilkins III |
First Address | Quincy, IL 62301-4038 |
Second Address | Quincy, IL 62301-4038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 14/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F76674 | (02) | MO |