Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2355012 | WI |
NPI | 1023050994 |
---|---|
Provider Name | Dr. Brian L Anderson |
First Address | Oshkosh, WI 54902-5593 |
Second Address | Oshkosh, WI 54902-5593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 03/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38842700 | (05) | WI |
T65203 | (02) | WI |