Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 27851 | WI |
NPI | 1043344005 |
---|---|
Provider Name | Richard Windsor |
First Address | Green Bay, WI 54303-2728 |
Second Address | Green Bay, WI 54311-6519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 04/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31703400 | (05) | WI |
E84787 | (02) | WI |