Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 24527020 | WI |
NPI | 1003901877 |
---|---|
Provider Name | James V Grebner |
First Address | Rhinelander, WI 54501-8360 |
Second Address | Rhinelander, WI 54501-8360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30460600 | (05) | WI |
B53209 | (02) | WI |