MEDICARE: DOUGLAS E WILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	2008-0010	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8215212	OTHER	IL	BC/BS OF IL

General Provider Information

NPI Number	:	1326225053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS E WILES

Provider Business Mailing Address
First Line	:	1032 E KARSCH BLVD
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-3403
Country	:	US
Telephone Number	:	573-701-9015
Fax Number	:	573-701-0103

Provider Business Practice Location Address
First Line	:	1032 E KARSCH BLVD
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-3403
Country	:	US
Telephone Number	:	573-701-9015
Fax Number	:	573-701-0103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	08/23/2013

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Directions to “ DOUGLAS E WILES ” Practice Location

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