Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 604-025 | WI |
N | 213ES0103X | Foot & Ankle Surgery | 604-025 | WI |
NPI | 1093711491 |
---|---|
Provider Name | Dr. Timothy Kevin Tougas |
First Address | Appleton, WI 54911-8582 |
Second Address | Appleton, WI 54911-8582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 16/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
391776284013 | BLUE CROSS BLUE SHIELD (01) | WI |
43222200 | (05) | WI |
BT1034026 | DEA NUMBER (01) | WI |
T39093 | (02) | WI |