Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 036-131736 | IL |
Y | 2084N0600X | Clinical Neurophysiologist | 036-131736 | IL |
NPI | 1043247083 |
---|---|
Provider Name | James M Gilchrist |
First Address | Springfield, IL 62794-9643 |
Second Address | Springfield, IL 62702-4968 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036131736 | (05) | IL |
7002090 | (05) | RI |
C84041 | (02) | RI |