Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 30862 | IA |
N | 207YP0228X | Pediatric Otolaryngology | 30862 | IA |
NPI | 1265429609 |
---|---|
Provider Name | Jose M Manaligod |
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 | 30/09/2005 |
Last Update Date | 12/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0130526 | (05) | IA |
52291 | WELLMARK BCBS (01) | IA |
G15256 | (02) |