Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 451 | TX |
N | 222Z00000X | Podiatrist | 451 | TX |
Y | 224P00000X | Prosthetist | 451 | TX |
NPI | 1417217357 |
---|---|
Provider Name | Mr. Gregory Paul Wimbish |
First Address | Waxahachie, TX 75165-2221 |
Second Address | Waxahachie, TX 75165-2221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 25/05/2012 |