Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-065155 | IL |
NPI | 1073609657 |
---|---|
Provider Name | Robert E. Finch JR. |
First Address | Springfield, IL 62703-2403 |
Second Address | Springfield, IL 62703-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 13/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036065155 | (05) | IL |
D14927 | (02) |