Provider Demographics
NPI:1104862010
Name:MCLAUGHLIN, JEFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54957-0381
Mailing Address - Country:US
Mailing Address - Phone:920-233-0123
Mailing Address - Fax:920-223-0370
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-223-0123
Practice Address - Fax:920-223-0370
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33651207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31914500Medicaid
WIE78999Medicare UPIN
WI000071393Medicare ID - Type Unspecified