Provider Demographics
NPI:1366641334
Name:WILCH, JERRY M (CPO)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:M
Last Name:WILCH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DUMC 3885
Mailing Address - Street 2:M04 DAVISON BLDG
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-2474
Mailing Address - Fax:919-681-8496
Practice Address - Street 1:BOX 3885 DUMC
Practice Address - Street 2:M04 DAVISON BLDG
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-2474
Practice Address - Fax:919-681-8496
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier