Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 40331 | WI |
NPI | 1023126174 |
---|---|
Provider Name | Matthew Hall |
First Address | Weston, WI 54476-5216 |
Second Address | Weston, WI 54476-5216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32593100 | (05) | WI |
H02109 | (02) |