Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 39578 | WI |
Y | 208600000X | Surgeon | 39578 | WI |
N | 2082S0105X | Plastic Hand Surgeon | 39578 | WI |
NPI | 1932394962 |
---|---|
Provider Name | Dr. Jeffrey A Herold |
First Address | Sheboygan, WI 53081-1927 |
Second Address | Sheboygan, WI 53081-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 18/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32429800 | (05) | WI |
G75060 | (02) | WI |