Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 31385-020 | WI |
NPI | 1013024207 |
---|---|
Provider Name | Dr. John V Selthafner |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-4526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013024207 | (05) | WI |
BS2406949 | DEA NUMBER (01) | |
E90017 | (02) |