Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101258246 | VA |
N | 207P00000X | Emergency Physician | DR.0056540 | CO |
Y | 207P00000X | Emergency Physician | MD-45014 | IA |
N | 207RC0200X | Critical Care Medicine | 0101258246 | VA |
N | 207RP1001X | Pulmonary Disease | 0101258246 | VA |
NPI | 1083970578 |
---|---|
Provider Name | Heather L. Groth |
First Address | Iowa City, IA 52245-2633 |
Second Address | Iowa City, IA 52245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 12/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DR.0056540 | COLORADO MEDICAL LICENSE (01) | CO |