Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01073878A | IN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01073878A | IN |
NPI | 1093988107 |
---|---|
Provider Name | Jason R Wiles |
First Address | Belfast, ME 04915-4021 |
Second Address | Evansville, IN 47714-0541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 04/04/2017 |