Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 38889 | IA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD-38889 | IA |
NPI | 1588871859 |
---|---|
Provider Name | Dr. Jason Lewis Picconi |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50314-3068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 25/02/2021 |