Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 22366 | IA |
NPI | 1033163217 |
---|---|
Provider Name | Dr. Leopoldo E. Delucca |
First Address | Fort Dodge, IA 50501-5742 |
Second Address | Fort Dodge, IA 50501-5742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 10/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1189068 | (05) | IA |
A02950 | (02) | IA |