Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 29250 | IA |
Y | 208600000X | Surgeon | 29250 | IA |
NPI | 1003869397 |
---|---|
Provider Name | Brian Daniel Gerrelts |
First Address | Waterloo, IA 50704-2758 |
Second Address | Waterloo, IA 50701-4588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1098236 | (05) | IA |
19243 | WELLMARK INS PLAN (01) | IA |
42141730707 | JOHN DEERE HEALTH INS PLA (01) | IA |