Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 238 | WV |
N | 213ES0103X | Foot & Ankle Surgery | 36002849W | OH |
N | 213ES0103X | Foot & Ankle Surgery | SC0031702 | PA |
NPI | 1063412401 |
---|---|
Provider Name | Jeffrey B Wilps |
First Address | Weirton, WV 26062-5309 |
Second Address | Weirton, WV 26062-5309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0099550000 | (05) | WV |
0757122 | (05) | OH |
480030330 | RAILROAD MEDICARE (01) | |
T82036 | (02) | WV |