Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 33838 | IA |
NPI | 1245214436 |
---|---|
Provider Name | Julie L Anderson-Suddarth |
First Address | Des Moines, IA 50309-1406 |
Second Address | Des Moines, IA 50309-1406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 26/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0470849 | (05) | IA |
H78442 | (02) | |
I16623 | MEDICARE (01) |