Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 42084 | WI |
NPI | 1013093178 |
---|---|
Provider Name | Mr. Cully R White |
First Address | Milwaukee, WI 53215 |
Second Address | Milwaukee, WI 53215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G39092 | (02) |