Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 24449 | NE |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 4301114122 | MI |
NPI | 1043485139 |
---|---|
Provider Name | Victor Adalbert Geraldez De Villa |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54301-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 05/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10026133000 | (05) | NE |
10026169400 | (05) | NE |
P00705495 | RAILROAD MEDICARE (01) | NE |