Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 23018 | WI |
Y | 208600000X | Surgeon | 23018 | WI |
NPI | 1023087103 |
---|---|
Provider Name | William R Deshur |
First Address | Milwaukee, WI 53215-3669 |
Second Address | Milwaukee, WI 53215-3669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30324600 | (05) | WI |
B52403 | (02) | WI |