Individual
DR. JACOB TAIT DEMASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1813 ASHLAND AVE, SHEBOYGAN, WI 53081-6125
(920) 458-4010
Mailing address
1813 ASHLAND AVE, SHEBOYGAN, WI 53081-6125
(920) 458-4010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101020370
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100058168
—
WI
Enumeration date
05/19/2013
Last updated
11/30/2021
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