Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 42766 | WI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 42766 | WI |
NPI | 1235141334 |
---|---|
Provider Name | Daniel D Priebe |
First Address | Wausau, WI 54401-6312 |
Second Address | Wausau, WI 54401-6312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 05/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30098400 | (05) | WI |
BP2312914 | DEA # (01) | WI |
F01945 | (02) | WI |