Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20750 | IA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 20750 | IA |
NPI | 1326034117 |
---|---|
Provider Name | Gerald J Jogerst |
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 | 27/09/2005 |
Last Update Date | 05/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101584 | (05) | IA |
10875 | WELLMARK BCBS (01) | IA |
C99708 | (02) |