Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 69843 | WI |
NPI | 1114079910 |
---|---|
Provider Name | Dr. Jeffrey J. Du Bois |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 12/01/2021 |