Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 632 | IA |
NPI | 1053314740 |
---|---|
Provider Name | Dr. Robert S Kelsey |
First Address | Dubuque, IA 52001-6358 |
Second Address | Dubuque, IA 52001-6358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 26/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0167551 | (05) | IA |
56750 | (02) | IA |