Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036113866 | IL |
NPI | 1215058490 |
---|---|
Provider Name | Ms. Gwyneth Smith Thompson |
First Address | Springfield, IL 62794-9639 |
Second Address | Springfield, IL 62702-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036113866 | (05) | IL |