Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 33949-020 | WI |
NPI | 1093761223 |
---|---|
Provider Name | Jeffery E Masciopinto |
First Address | Madison, WI 53715-1830 |
Second Address | Madison, WI 53715-1830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093761223 | (05) | WI |
F68014 | (02) |