Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 42772020 | WI |
N | 111NI0900X | Internist | 42772020 | WI |
N | 208000000X | Pediatrician | 42772020 | WI |
NPI | 1003985284 |
---|---|
Provider Name | Dr. Kansas L Du Bray |
First Address | Baraboo, WI 53913 |
Second Address | Baraboo, WI 53913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14466 | DEAN HEALTH PLAN (01) | |
34175500 | (05) | WI |
H58745 | (02) | WI |
P00054953 | RAILROAD RETIREMENT (01) |