Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 19918 | WI |
NPI | 1013022508 |
---|---|
Provider Name | Thomas G Gerber JR. |
First Address | Marshfield, WI 54449-5703 |
Second Address | Rice Lake, WI 54868-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30440200 | (05) | WI |
B53040 | (02) |