Doctor Name: | ROB WIMMER |
NPI Number: | 1013972512 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | 085000410 |
Business Practice Address: | 7309 N Knoxville Ave Peoria, IL - 616142085 |
Business Phone Number: | 3096929898 |
Business Fax Number: | |
Mailing Address: | 7309 N Knoxville Ave, PEORIA |
State: | IL |
Postal Code: | 616142085 |
Phone Number: | 3096929898 |
Fax Number: | |
NPI Enumeration Date: | 04/18/2006 |
NPI Last Update Date: | 01/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 085000410 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |