Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 51493-20 | WI |
Y | 111NI0900X | Internist | 51493-20 | WI |
N | 207RA0401X | Internist - Addiction Medicine | 51493 | WI |
NPI | 1891725420 |
---|---|
Provider Name | Dr. Paul Steven Board |
First Address | Sturgeon Bay, WI 54235 |
Second Address | Sturgeon Bay, WI 54235-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 20/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E24365 | (02) | IL |