Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 00007930 | AL |
NPI | 1083619332 |
---|---|
Provider Name | Wiley Hugh Justice |
First Address | Mobile, AL 36688-0277 |
Second Address | Mobile, AL 36688-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 04/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000034502 | (05) | AL |
4006616 | AETNA PROVIDER # (01) | AL |
51034502 | BLUE CROSS PROVIDER # (01) | AL |
51511917 | BLUE CROSS AL PROVIDER # (01) | AL |
C71226 | (02) | |
C71226 | HEALTHSPRING PROVIDER # (01) | AL |