Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 1747 | IA |
NPI | 1174960793 |
---|---|
Provider Name | Joel Waddell |
First Address | Des Moines, IA 50309-1419 |
Second Address | Des Moines, IA 50309-1419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2013 |
Last Update Date | 07/04/2020 |