Individual
DR. WAYNE ANTON MISSELBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36 S MAIN ST, GIFFORD MEDICAL CENTER EMERGENCY DEPARTMENT, RANDOLPH, VT 05060-1370
(802) 728-7000
Mailing address
161 ATKINS BAY LN, NORTH HERO, VT 05474-9757
(802) 372-3449
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
42-0007390
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009231
—
VT
05
—
80009231
—
NH
05
—
E01066279
—
NY
Enumeration date
07/10/2006
Last updated
02/07/2014
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