Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2013015482 | MO |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 53757-20 | WI |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 8995595-1205 | UT |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD-43426 | IA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD2015-0203 | NM |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MED-PHYS-LIC-33185 | MT |
NPI | 1073786521 |
---|---|
Provider Name | Dr. Shane A Gailushas |
First Address | Cedar Rapids, IA 52401 |
Second Address | Cedar Rapids, IA 52401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 09/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073786521 | (05) | MO |