Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 16162 | NV |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 2013001919 | MO |
NPI | 1679558290 |
---|---|
Provider Name | Gregory Paul Harbach |
First Address | Rhinelander, WI 54501-2852 |
Second Address | Rhinelander, WI 54501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 05/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1679558290 | (05) | MO |
1679558290 | (05) | NV |
200974430A | (05) | KS |
948-320 | STATE LICENSE (01) | WI |