Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 34600 | IA |
Y | 208200000X | Surgeon | 34600 | IA |
Y | 208600000X | Surgeon | 34600 | IA |
N | 2086S0120X | Pediatric Surgery | 34600 | IA |
NPI | 1487655049 |
---|---|
Provider Name | John J Meehan |
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 | 04/08/2005 |
Last Update Date | 14/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0268805 | (05) | IA |
47889 | WELLMARK BCBS (01) | IA |
F87610 | (02) |