Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 92505 | IA |
N | 222Z00000X | Podiatrist | 92505 | IA |
N | 213EP1101X | Primary Podiatric Medicine | 92505 | IA |
Y | 213ES0103X | Foot & Ankle Surgery | 92505 | IA |
NPI | 1578058962 |
---|---|
Provider Name | Dr. Dallen Pope |
First Address | Waterloo, IA 50702-5401 |
Second Address | Waterloo, IA 50702-5401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 27/06/2018 |