Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 37472-020 | WI |
NPI | 1003898255 |
---|---|
Provider Name | Clay Jamison Frank |
First Address | Wauwatosa, WI 53226-4339 |
Second Address | Wauwatosa, WI 53226-4339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 03/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G23983 | (02) | WI |