Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 08496 | IA |
NPI | 1134317845 |
---|---|
Provider Name | Dr. Tobin Norman Drake |
First Address | Iowa City, IA 52240-2331 |
Second Address | Iowa City, IA 52242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 09/10/2007 |