Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 37648 | WI |
NPI | 1275564221 |
---|---|
Provider Name | Dr. Greg Peter Watchmaker |
First Address | Mequon, WI 53092-5053 |
Second Address | Mequon, WI 53092-5053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32228800 | (05) | WI |
G28314 | (02) | WI |