Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 57622-021 | WI |
N | 207XS0106X | Orthopaedic Hand Surgeon | 57622-021 | WI |
Y | 2086S0105X | Surgery of the Hand | 57622-021 | WI |
NPI | 1972738615 |
---|---|
Provider Name | Dr. Matthew J. Boardman |
First Address | Madison, WI 53716-2257 |
Second Address | Madison, WI 53716-2257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1972738615 | (05) | WI |