Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 26040 | WI |
NPI | 1053454165 |
---|---|
Provider Name | Dr. Frederic W Schmidt |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54301-3234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 18/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000107105 | MEDICARE PTAN (01) | WI |
31390600 | (05) | WI |
B56375 | (02) | WI |