Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 24286 | IA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 24286 | IA |
NPI | 1962495176 |
---|---|
Provider Name | John W Canady |
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 | 24/08/2005 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0297572 | (05) | IA |
29757 | WELLMARK BCBS (01) | IA |
E44363 | (02) |