Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6494 | IA |
NPI | 1093778516 |
---|---|
Provider Name | Dr. Eugene R Pankey |
First Address | W Burlington, IA 52655-1691 |
Second Address | W Burlington, IA 52655-1691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 04/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1117168 | (05) | IA |
U51407 | (02) | IA |