Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DDS-09418 | IA |
Y | 213EG0000X | General Practice | DDS-09418 | IA |
NPI | 1003345000 |
---|---|
Provider Name | Dr. Patrick David Kolker |
First Address | Clear Lake, IA 50428-1080 |
Second Address | Mason City, IA 50401-3250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2017 |
Last Update Date | 05/06/2017 |