Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 101766 | MO |
NPI | 1093709636 |
---|---|
Provider Name | Steven B Wilkinson |
First Address | Independence, MO 64057-2303 |
Second Address | Independence, MO 64057-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 21/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100139680D | (05) | KS |
206748204 | (05) | MO |
F26908 | (02) | MO |