Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 31704 | WI |
NPI | 1013028174 |
---|---|
Provider Name | Gary Bailey |
First Address | Marshfield, WI 54449-5777 |
Second Address | Minocqua, WI 54548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31652100 | (05) | WI |
B08510 | (02) |