Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101022503 | MI |
NPI | 1275980989 |
---|---|
Provider Name | Jens Brown |
First Address | Altoona, WI 54720-2668 |
Second Address | Altoona, WI 54720-2668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2016 |
Last Update Date | 29/06/2021 |