Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | A5374 | IA |
NPI | 1578593240 |
---|---|
Provider Name | Dr. Duane Alan Widen |
First Address | Evansdale, IA 50707-1121 |
Second Address | Evansdale, IA 50707-1121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0287862 | (05) | IA |
U01947 | (02) | IA |