Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 578 | IA |
Y | 222Z00000X | Podiatrist | 578 | IA |
N | 213E00000X | Podiatrist | 991 | WI |
N | 222Z00000X | Podiatrist | 991 | WI |
N | 213EP1101X | Primary Podiatric Medicine | 578 | IA |
N | 213EP1101X | Primary Podiatric Medicine | 991 | WI |
NPI | 1356307185 |
---|---|
Provider Name | Dr. Gregory James Valkosky |
First Address | La Crosse, WI 54601-5429 |
Second Address | Decorah, IA 52101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 12/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101121 | (05) | IA |
12710 | (02) | WI |
U43659 | (02) | IA |