Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4900 | OK |
NPI | 1083601686 |
---|---|
Provider Name | James A Wimsatt III |
First Address | Eagle River, AK 99577-6709 |
Second Address | Elmendorf Afb, AK 99506-3702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 07/08/2008 |