Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 61-4418 | IL |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036-059865 | IL |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MC-0085 | ID |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD-45006 | IA |
NPI | 1609818657 |
---|---|
Provider Name | James A Meserow |
First Address | Des Moines, IA 50309-1406 |
Second Address | Grand Forks, ND 58201-6009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-059865 | (05) | IL |
1609818657 | (05) | IA |