Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 53175 | WI |
Y | 111NI0900X | Internist | 53175 | WI |
N | 208000000X | Pediatrician | 53175 | WI |
NPI | 1003940784 |
---|---|
Provider Name | Dr. Dennis Banez Zaide |
First Address | Waukesha, WI 53186-2939 |
Second Address | Waukesha, WI 53186-2939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 07/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003940784 | (05) | WI |
278423800 | (05) | FL |