Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 40008 | IA |
NPI | 1043487937 |
---|---|
Provider Name | Dr. Patrick C Chua |
First Address | Des Moines, IA 50314-3026 |
Second Address | Des Moines, IA 50314-3017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2008 |
Last Update Date | 06/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043487937 | (05) | IA |
1043487937 | WELLMARK BCBS (01) | IA |
P01095595 | RR MEDICARE (01) | IA |