Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | IL | |
N | 222Z00000X | Podiatrist | IL | |
N | 224P00000X | Prosthetist | IL |
NPI | 1255318176 |
---|---|
Provider Name | Mr. William Robert Devlin |
First Address | Urbana, IL 61801-4220 |
Second Address | Urbana, IL 61801-4220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113686141001 | (05) | IL |
CPO02628 | ABC CERTIFICATION NUMBER (01) | IL |