Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 21292 | WI |
NPI | 1003917303 |
---|---|
Provider Name | Dr. David R Mertens |
First Address | Marinette, WI 54143-1134 |
Second Address | Marinette, WI 54143-4242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 21/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30346700 | (05) | WI |
AM9453072 | DEA NUMBER (01) | |
B55040 | (02) |