Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 036092911 | IL |
N | 208800000X | Urologist | 036092911 | IL |
NPI | 1114913225 |
---|---|
Provider Name | Thomas H Tarter |
First Address | Decatur, IL 62526-5858 |
Second Address | Decatur, IL 62526-5858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 29/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036092911 | (05) | IL |
G34757 | (02) |