Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 5001199 | WI |
NPI | 1811077449 |
---|---|
Provider Name | Dr. David M Angell |
First Address | Oshkosh, WI 54901-2570 |
Second Address | Oshkosh, WI 54904-7247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 05/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0040023890 | BLUE CROSS BLUE SHIELD (01) | |
70010800 | (05) | WI |
T61370 | (02) | WI |