Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 24971 | WI |
N | 207QA0401X | Family Doctor - Addiction Medicine | 24971 | WI |
NPI | 1861495913 |
---|---|
Provider Name | Dr. Robert Sutton Lea |
First Address | Green Bay, WI 54307-9070 |
Second Address | Chippewa Falls, WI 54729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 26/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001 | ADVOCARE (01) | WI |
01-19481 | MEDICA (01) | WI |
1020 | GREATER MARSFIELD PLAN (01) | WI |
301025868 | PREFERRED ONE (01) | WI |
301813 | CCN (01) | WI |
30499400 | (05) | WI |
30499400 | WISCONSIN RISK (01) | WI |
3080003725 | TRAVELERS RAILROAD (01) | WI |
391435797 | EMPLOYERS HEALTH (01) | WI |
4F991LE | ATRIUM (01) | WI |
4F991LE | ATRIUM SENIOR PLAN (01) | WI |
4F991LE | BLUE CROSS MINNESOTA (01) | WI |
B54489 | (02) | WI |
B54489 | GROUP HEALTH (01) | WI |
B54489 | MA GROUP HEALTH (01) | WI |
W005284 | CHAMPUS (01) | WI |