Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 21696 | IA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 21696 | IA |
NPI | 1154316636 |
---|---|
Provider Name | John J Callaghan |
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 | 12/09/2005 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0299537 | (05) | IA |
29953 | WELLMARK BCBS (01) | IA |
C83104 | (02) |