Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 36962 | WI |
NPI | 1164403226 |
---|---|
Provider Name | Michael W Jones |
First Address | Fond Du Lac, WI 54935-4560 |
Second Address | Fond Du Lac, WI 54935-3734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110143298 | RAILROAD MEDICARE (01) | WI |
32331100 | (05) | WI |