Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 66347 | WI |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 66347 | WI |
NPI | 1003112947 |
---|---|
Provider Name | Brian Thomas Zafonte |
First Address | Mount Pleasant, WI 53405-1667 |
Second Address | Mount Pleasant, WI 53405-1667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2011 |
Last Update Date | 10/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201236810 | (05) | IN |