Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 11521 | NH |
NPI | 1134153604 |
---|---|
Provider Name | Jeffrey W Wiley |
First Address | Concord, NH 03301-2551 |
Second Address | Concord, NH 03301-2551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 01/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30202240 | (05) | NH |
H42000 | (02) |