Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 42976 | WI |
NPI | 1033170428 |
---|---|
Provider Name | Dr. Benjamin S Gozon III |
First Address | Milwaukee, WI 53222-1827 |
Second Address | Milwaukee, WI 53222-1827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 28/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34058300 | (05) | WI |
G96529 | (02) | WI |