Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3491 | WI |
NPI | 1235294026 |
---|---|
Provider Name | Dr. Scott A Capesius |
First Address | Green Bay, WI 54304-3768 |
Second Address | Green Bay, WI 54304-3768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 30/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38908200 | (05) | WI |
U71390 | (02) | WI |