Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001030 | MI |
Y | 222Z00000X | Podiatrist | 5901001030 | MI |
NPI | 1033126743 |
---|---|
Provider Name | Charles Murray Wax |
First Address | Bay City, MI 48706-2318 |
Second Address | Saginaw, MI 48602-5251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 21/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2122755 | (05) | MI |
5095000 | BLUE CROSS/BLUE SHILED (01) | MI |
T33921 | (02) |