Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 24577 | WI |
NPI | 1023097417 |
---|---|
Provider Name | Leland Robert Mayer |
First Address | Eau Claire, WI 54702-1510 |
Second Address | Eau Claire, WI 54703-5222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 15/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30735400 | (05) | WI |
B54891 | (02) |