Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 16104 | IA |
NPI | 1255655635 |
---|---|
Provider Name | Dr. David Gerhardt Paulsrud |
First Address | Sioux City, IA 51104-1075 |
Second Address | Sioux City, IA 51101-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 15/03/2010 |