Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 38070-20 | WI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 38070-20 | WI |
NPI | 1770518540 |
---|---|
Provider Name | Thomas M Mcgorey |
First Address | Jefferson, WI 53549-2048 |
Second Address | Johnson Creek, WI 53094-8511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 18/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32416700 | (05) | WI |
G65494 | (02) | WI |