Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25543 | IA |
N | 111NI0900X | Internist | 25543 | IA |
Y | 207RI0200X | Infectious Disease | 25543 | IA |
NPI | 1083603773 |
---|---|
Provider Name | Jack T Stapleton |
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 | 17/10/2005 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0238857 | (05) | IA |
23885 | WELLMARK BCBS (01) | IA |
A03042 | (02) |