Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 35119 | IA |
NPI | 1639123243 |
---|---|
Provider Name | David James Congdon |
First Address | Waterloo, IA 50704-2758 |
Second Address | Waterloo, IA 50701-9746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 04/02/2022 |