Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 65133-20 | WI |
NPI | 1003226259 |
---|---|
Provider Name | Parker Hoerz |
First Address | Madison, WI 53704-4155 |
Second Address | Madison, WI 53704-4155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2014 |
Last Update Date | 18/02/2020 |