Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 28549 | WI |
N | 2081P2900X | Pain Medicine | 28549 | WI |
NPI | 1366554321 |
---|---|
Provider Name | Dr. James David Lincer |
First Address | Wauwatosa, WI 53226-1403 |
Second Address | Wauwatosa, WI 53226-1403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137184000 | US DEPT OF LABOR ID (01) | WI |
21280000 | (05) | WI |
31543800 | (05) | WI |
391706314 | GROUP TAX IDENTIFICATION (01) | WI |
BL2022743 | DEA (01) | WI |
E30975 | (02) | WI |