Individual
DOUGLAS B MOERICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
18601 LINCOLN ST, WHITEHALL, WI 54773-8605
(715) 538-4361
Mailing address
18601 LINCOLN ST, WHITEHALL, WI 54773-8605
(715) 538-1712
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
492
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42940400
—
WI
Enumeration date
06/13/2005
Last updated
03/19/2019
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