Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036095607 | IL |
N | 207XS0106X | Orthopaedic Hand Surgeon | 036-095607 | IL |
NPI | 1164535837 |
---|---|
Provider Name | Brian J Bear |
First Address | Milwaukee, IL 53278 |
Second Address | Rockford, IL 61107-5090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036095607 | (05) | IL |
G35990 | (02) | IL |