Healthcare Provider Details

I. General information

NPI: 1780792267
Provider Name (Legal Business Name): ROBERT CLEMENT WUBBEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 S COMMERCIAL ST
NEENAH WI
54956-4802
US

IV. Provider business mailing address

PO BOX 8003
APPLETON WI
54912-8003
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-0077
  • Fax: 920-725-6535
Mailing address:
  • Phone: 920-996-3200
  • Fax: 920-725-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number23907
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: