Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 19194 | WI |
Y | 208600000X | Surgeon | 19194 | WI |
NPI | 1013917079 |
---|---|
Provider Name | Jeffrey A Kurtz |
First Address | Wausau, WI 54401-4123 |
Second Address | Wausau, WI 54401-4123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 03/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30348300 | (05) | WI |
B54387 | (02) |