Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 730 | WI |
N | 213ES0103X | Foot & Ankle Surgery | 730 | WI |
N | 213ES0131X | Foot Surgery | 730 | WI |
NPI | 1184632341 |
---|---|
Provider Name | Stephen C Bogue |
First Address | Madison, WI 53719 |
Second Address | Madison, WI 53719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 20/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43221700 | (05) | WI |
U62165 | (02) |