Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 26997 | IA |
NPI | 1407922768 |
---|---|
Provider Name | Dr. Phyllis Chang |
First Address | Coralville, IA 52241-2304 |
Second Address | Coralville, IA 52241-2304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1273599 | (05) | IA |
E07320 | (02) | IA |