Provider Demographics
NPI:1760459556
Name:CLAPPER, WINGATE FOSTER (MD)
Entity Type:Individual
Prefix:
First Name:WINGATE
Middle Name:FOSTER
Last Name:CLAPPER
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 677
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53187-0677
Mailing Address - Country:US
Mailing Address - Phone:262-696-0710
Mailing Address - Fax:262-696-5680
Practice Address - Street 1:N16W24131 RIVERWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-696-0696
Practice Address - Fax:262-696-0683
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI301912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31523500Medicaid
683950002Medicare ID - Type Unspecified
WI31523500Medicaid
WI92000089Medicare PIN