Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD-32196 | IA |
Y | 208600000X | Surgeon | MD-32196 | IA |
N | 2086X0206X | Surgical Oncologist | MD-32196 | IA |
NPI | 1407841505 |
---|---|
Provider Name | Dr. Daniel Robert Kollmorgen |
First Address | West Des Moines, IA 50266-9313 |
Second Address | Des Moines, IA 50309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F56863 | (02) | IA |