Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 4301105189 | MI |
Y | 207K00000X | Allergist & Immunologist | 46985 | WI |
N | 207R00000X | Internist | 46985-20 | WI |
N | 111NI0900X | Internist | 46985-20 | WI |
NPI | 1215982368 |
---|---|
Provider Name | Alan W James |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54301-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 25/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G57614 | (02) | WI |