Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 5464 | WI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 5464 | WI |
NPI | 1083714737 |
---|---|
Provider Name | Weiguang Ma |
First Address | Marshfield, WI 54449-5777 |
Second Address | Marshfield, WI 54449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33772800 | (05) | WI |
U90583 | (02) |