Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2343-19 | WI |
NPI | 1043767296 |
---|---|
Provider Name | Scott Anderson |
First Address | Arcadia, WI 54612-1401 |
Second Address | Arcadia, WI 54612-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 06/09/2016 |