Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 36472 | WI |
NPI | 1013017938 |
---|---|
Provider Name | Louis A Benoist |
First Address | Neillsville, WI 54456 |
Second Address | Neillsville, WI 54456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32124300 | (05) | WI |
A13408 | (02) |