Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 28587 | IA |
N | 111NI0900X | Internist | 28587 | IA |
Y | 207U00000X | Nuclear Medicine Specialist | 28587 | IA |
NPI | 1104814094 |
---|---|
Provider Name | David L Bushnell JR. |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0081976 | (05) | IA |
07442 | WELLMARK BCBS (01) | IA |
E96111 | (02) |