Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 26230-20 | WI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 27110 | IA |
NPI | 1184621468 |
---|---|
Provider Name | Dr. David Seeger Tearse |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54301-3528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 02/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184621468 | (05) | IA |
23758 | BLUE CROSS/BLUE SHIELD (01) | IA |
E07342 | (02) | IA |