Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3434 | WI |
NPI | 1932317096 |
---|---|
Provider Name | Dr. Scott Harold Wruck |
First Address | Green Bay, WI 54304-5376 |
Second Address | Green Bay, WI 54304-5376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 08/07/2007 |