Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 53149 | WI |
NPI | 1265632574 |
---|---|
Provider Name | Dr. Alex Thomas |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53715-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 13/07/2012 |