Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0003237 | WI |
NPI | 1003952607 |
---|---|
Provider Name | Mr. Douglas D Podoll |
First Address | Amery, WI 54001 |
Second Address | Amery, WI 54001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |