Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 663 | IA |
Y | 222Z00000X | Podiatrist | 663 | IA |
NPI | 1013944412 |
---|---|
Provider Name | Dr. Ronald M Kane |
First Address | Waterloo, IA 50702-5063 |
Second Address | Waterloo, IA 50702-5619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3152488 | (05) | IA |
U67917 | (02) | IA |