Individual
DR. ROGER C MIXTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5201 N PORT WASHINGTON RD, MILWAUKEE, WI 53217-4902
(414) 963-0500
(414) 963-0359
Mailing address
5201 N PORT WASHINGTON RD, MILWAUKEE, WI 53217-4902
(414) 963-0500
(414) 963-0359
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
26326
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30618600
—
WI
Enumeration date
05/19/2006
Last updated
07/08/2007
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