Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 45082 | WI |
NPI | 1043208952 |
---|---|
Provider Name | Wayne A Brearley |
First Address | Wausau, WI 54401-4705 |
Second Address | Wausau, WI 54401-4705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 21/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34340200 | (05) | WI |
H75967 | (02) |