Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 38197 | IA |
N | 111NI0900X | Internist | 38197 | IA |
Y | 207RA0201X | Internist - Allergy & Immunology | 38197 | IA |
NPI | 1346450012 |
---|---|
Provider Name | Brad J Mcclimon |
First Address | Dubuque, IA 52002-2201 |
Second Address | Dubuque, IA 52002-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 07/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I74373 | (02) | MN |