Doctor Name: | JEFFERY DALE WIRGAU |
NPI Number: | 1003122169 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PAC |
License Number: | 5601005846 |
Business Practice Address: | 400 Johnson St Alpena, MI - 497071434 |
Business Phone Number: | 9893562161 |
Business Fax Number: | |
Mailing Address: | 3267 W Nicholson Hill Rd, OSSINEKE |
State: | MI |
Postal Code: | 497669722 |
Phone Number: | 9895901977 |
Fax Number: | |
NPI Enumeration Date: | 08/27/2010 |
NPI Last Update Date: | 08/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5601005846 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |