Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 26831 | WI |
N | 2080P0201X | Pediatric Allergist | 29460 | IA |
N | 2080P0201X | Pediatric Allergist | 37440 | MN |
NPI | 1659374411 |
---|---|
Provider Name | Todd A Mahr |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 08/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30685900 | (05) | WI |
B54767 | (02) |