Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 25482 | WI |
NPI | 1104897156 |
---|---|
Provider Name | James F Winston |
First Address | Green Bay, WI 54305-1446 |
Second Address | Green Bay, WI 54301-3526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2676010 | (05) | MI |
30539400 | (05) | WI |
B57668 | (02) |