Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A126297 | IA |
NPI | 1003299702 |
---|---|
Provider Name | Dr. Ryan Flug |
First Address | Des Moines, IA 50322-5304 |
Second Address | Des Moines, IA 50320-1109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 23/07/2015 |