Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2178 | WV |
NPI | 1568563179 |
---|---|
Provider Name | James W Kribs |
First Address | Green Bay, WI 54307-9070 |
Second Address | Green Bay, WI 54313-7152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810005977 | (05) | WV |
I60796 | (02) |