Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 37103 | IA |
NPI | 1003030628 |
---|---|
Provider Name | Dr. Thomas M Wernimont |
First Address | Des Moines, IA 50305-4925 |
Second Address | Des Moines, IA 50314-2611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 04/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37103 | STATE MEDICAL LICENSE (01) | IA |