Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | M4963 | TX |
Y | 207RA0201X | Internist - Allergy & Immunology | PT11501 | ND |
NPI | 1457419616 |
---|---|
Provider Name | Dr. Benoit D Tano |
First Address | Onalaska, WI 54650-6758 |
Second Address | Onalaska, WI 54650-6758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M4963 | TEXAS MEDICAL LICENSE (01) |