Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 676 | WI |
Y | 222Z00000X | Podiatrist | 676 | WI |
N | 213EP1101X | Primary Podiatric Medicine | 676 | WI |
N | 213ES0131X | Foot Surgery | 676 | WI |
NPI | 1508879826 |
---|---|
Provider Name | William Chubb |
First Address | Madison, WI 53719-1011 |
Second Address | Madison, WI 53719-1011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 24/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43219900 | (05) | WI |
U50470 | (02) |