Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 27480 | IA |
N | 207VE0102X | Reproductive Endocrinologist | 27480 | IA |
Y | 207VE0102X | Reproductive Endocrinologist | 71612 | WI |
NPI | 1144214339 |
---|---|
Provider Name | Bradley J Vanvoorhis |
First Address | Iowa City, IA 52246-8671 |
Second Address | Iowa City, IA 52246-8671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0297663 | (05) | IA |
29766 | WELLMARK BCBS (01) | IA |
B75073 | (02) |