Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | R-11164 | IA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | R-11164 | IA |
N | 207XS0106X | Orthopaedic Hand Surgeon | R-11164 | IA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | R-11164 | IA |
N | 207XS0117X | Orthopaedic Spine Surgeon | R-11164 | IA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | R-11164 | IA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | R-11164 | IA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | R-11164 | IA |
NPI | 1780175281 |
---|---|
Provider Name | Dr. Trevor Robert Gulbrandsen |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2018 |
Last Update Date | 21/05/2018 |