Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 25311020 | WI |
NPI | 1023026903 |
---|---|
Provider Name | Dr. Apolinar Ed A Jovellana JR. |
First Address | Crandon, WI 54520-8149 |
Second Address | Crandon, WI 54520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000623040 | (02) | WI |
19078 | SECURITY HEALTH PLAN (01) | WI |
30527700 | (05) | WI |
B84955 | (02) |