Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 32996-020 | WI |
NPI | 1003810458 |
---|---|
Provider Name | Mrs. Martha F Jay |
First Address | Mequon, WI 53092-3411 |
Second Address | Mequon, WI 53092-3411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 29/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31810400 | (05) | WI |
F24120 | (02) | WI |