Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 2012-00803 | NC |
NPI | 1033214259 |
---|---|
Provider Name | Wilder Glover Little JR. |
First Address | Hendersonville, NC 28791-3410 |
Second Address | Hendersonville, NC 28739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 20/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000235485F | (05) | GA |
340003829 | RAILROAD MEDICARE (01) | GA |
D70549 | (02) |