Doctor Name: | WILLIAM PAUL KILGORE |
NPI Number: | 1104185495 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 1060 Gaffney Rd Fort Wainwright, AK - 997035001 |
Business Phone Number: | 9073615172 |
Business Fax Number: | |
Mailing Address: | 1448 Apple St Unit 2, FT WAINWRIGHT |
State: | AK |
Postal Code: | 997031314 |
Phone Number: | 8083753502 |
Fax Number: | |
NPI Enumeration Date: | 05/08/2012 |
NPI Last Update Date: | 05/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |