Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 26714-020 | WI |
Y | 208600000X | Surgeon | 26714-020 | WI |
NPI | 1013909647 |
---|---|
Provider Name | Philip Anthony Vogt |
First Address | Appleton, WI 54911-3454 |
Second Address | Appleton, WI 54911-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30660100 | (05) | WI |
B57365 | (02) |