Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 66430 | WI |
NPI | 1194769166 |
---|---|
Provider Name | Dr. David L Priebe |
First Address | Waukesha, WI 53186-1303 |
Second Address | Waukesha, WI 53186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47081633613 | (05) | NE |
H84372 | (02) | NE |