Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 1001041-15 | WI |
NPI | 1104984277 |
---|---|
Provider Name | Robert Walker Mier |
First Address | Wauwatosa, WI 53213-1137 |
Second Address | Wauwatosa, WI 53213-1137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 22/04/2015 |