Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 29238 | IA |
NPI | 1003897554 |
---|---|
Provider Name | Dr. Thomas James Benda JR. |
First Address | Dubuque, IA 52003-7704 |
Second Address | Dubuque, IA 52003-7704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 31/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100461 | (05) | IA |
040003712 | RAILROAD MEDICARE PROVIDE (01) | IA |
42098297112 | JOHN DEERE PROVIDER ID (01) | IA |
F61594 | (02) | IA |