Healthcare Provider Details

I. General information

NPI: 1104862010
Provider Name (Legal Business Name): JEFFREY R. MCLAUGHLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 9TH AVE SUITE 125
OSHKOSH WI
54904-7247
US

IV. Provider business mailing address

PO BOX 381
NEENAH WI
54957-0381
US

V. Phone/Fax

Practice location:
  • Phone: 920-223-0123
  • Fax: 920-223-0370
Mailing address:
  • Phone: 920-233-0123
  • Fax: 920-223-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number33651
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: