Individual
DR. JOHN EASTER WIMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
628 GREEN VALLEY RD, SUITE 210, GREENSBORO, NC 27408-7730
(336) 478-1016
(336) 851-1737
Mailing address
628 GREEN VALLEY RD, SUITE 210, GREENSBORO, NC 27408-7730
(336) 478-1016
(336) 851-1737
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25465
NC
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
25465
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5150034
AETNA
NC
01
—
88511
BCBS NC
NC
05
—
8988511
—
NC
01
—
C5375
MEDCOST
NC
Enumeration date
06/15/2006
Last updated
12/14/2011
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