Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 05960 | IA |
Y | 213EG0000X | General Practice | 05960 | IA |
NPI | 1003812017 |
---|---|
Provider Name | Dr. Stephen T Bender |
First Address | Iowa City, IA 52240-3111 |
Second Address | Iowa City, IA 52240-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26043 | DELTA DENTAL USA PROVIDER (01) | IA |
26043 | WELLMARK PROVIDER (01) | IA |