Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 64362-20 | WI |
N | 207ND0900X | Dermatopathologist | 64362-20 | WI |
NPI | 1427369396 |
---|---|
Provider Name | Dr. Solomon Shockman |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Wausau, WI 54401-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 02/08/2021 |