Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 47760-20 | WI |
NPI | 1053378331 |
---|---|
Provider Name | John R Ewing |
First Address | Madison, WI 53715-1507 |
Second Address | Madison, WI 53715-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2014182 | PHYSICIANS PLUS (01) | WI |
34628600 | (05) | WI |
60427 | DEAN HEALTH INSURANCE (01) | WI |
G31032 | (02) |