Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD-43972 | IA |
N | 207RH0003X | Hematology & Oncology | R-09931 | IA |
NPI | 1003103383 |
---|---|
Provider Name | Grerk Sutamtewagul |
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 | 07/07/2011 |
Last Update Date | 29/01/2020 |