Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 1931 | WI |
NPI | 1932326691 |
---|---|
Provider Name | Dr. Gregory Robert Daniels |
First Address | West Allis, WI 53227-1107 |
Second Address | West Allis, WI 53227-1107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1931 | STATE LICENSE (01) | WI |
38784900 | (05) | WI |