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Individual

DR. MARC A DEMOYA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9200 W WISCONSIN AVENUE, TRAUMA SURGERY, MILWAUKEE, WI 53226-3522
(414) 805-8623
(414) 805-8641
Mailing address
9200 W WISCONSIN AVENUE, TRAUMA SURGERY, MILWAUKEE, WI 53226-3522
(414) 805-8623
(414) 805-8641

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
223920
MA
2086S0102X
Surgical Critical Care Physician
223920
MA
2086S0102X
Surgical Critical Care Physician
Primary
67333
WI
2086S0127X
Trauma Surgery Physician
67333
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1588655781
WI
05
2103800
MA
01
468295
TUFTS HEALTH PLAN
MA
01
J28713
BCBS MA
MA
Enumeration date
11/04/2005
Last updated
07/21/2022
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