Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 03005 | IA |
N | 204C00000X | Sports Medicine Doctor | 036-063775 | IL |
N | 204C00000X | Sports Medicine Doctor | 40617 | MN |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 37512-04 | WI |
N | 207PE0004X | Emergency Medical Services | 03005 | IA |
N | 207PE0004X | Emergency Medical Services | 036-063775 | IL |
N | 207PE0004X | Emergency Medical Services | 37512-021 | WI |
N | 207PE0004X | Emergency Medical Services | 40617 | MN |
N | 207Q00000X | Family Doctor | 03005 | IA |
N | 207Q00000X | Family Doctor | 036-063775 | IL |
N | 207Q00000X | Family Doctor | 37512-021 | WI |
Y | 207Q00000X | Family Doctor | 40617 | MN |
NPI | 1083663967 |
---|---|
Provider Name | Lawrence Wesley Waite |
First Address | Onalaska, WI 54650-8772 |
Second Address | Onalaska, WI 54650-8772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 18/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E-37161 | (02) | WI |