Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 30083 | WI |
Y | 207X00000X | Orthopaedic Surgeon | 30083 | WI |
NPI | 1609841105 |
---|---|
Provider Name | Jeffrey B. Shovers |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Wauwatosa, WI 53222-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 25/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31506100 | (05) | WI |
F07069 | (02) | WI |
P01035283 | RR MEDICARE (01) | WI |