Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 28495 | WI |
NPI | 1023085487 |
---|---|
Provider Name | David A. Carron |
First Address | Milwaukee, WI 53215-3689 |
Second Address | Wauwatosa, WI 53226-3442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 25/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31603800 | (05) | WI |
E50670 | (02) | WI |