Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | R10054 | IA |
Y | 208600000X | Surgeon | R10054 | IA |
N | 2086S0102X | Surgical Critical Care | R10054 | IA |
N | 2086S0127X | Trauma Surgeon | R10054 | IA |
N | 2086S0129X | Vascular Surgeon | R10054 | IA |
NPI | 1063825693 |
---|---|
Provider Name | Justin Walpole |
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 | 11/06/2014 |
Last Update Date | 11/06/2014 |