Healthcare Provider Details

I. General information

NPI: 1275564221
Provider Name (Legal Business Name): GREG PETER WATCHMAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W MARKET ST
MEQUON WI
53092-5053
US

IV. Provider business mailing address

1535 W MARKET ST
MEQUON WI
53092-5053
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-9224
  • Fax: 262-241-9228
Mailing address:
  • Phone: 262-241-9224
  • Fax: 262-241-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number37648
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: