Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 30212 | IA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 30212 | IA |
NPI | 1225191836 |
---|---|
Provider Name | Marc A Shulman |
First Address | Ames, IA 50010 |
Second Address | Ames, IA 50010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0118752 | (05) | IA |
20185 | BCBS (01) | IA |
F44165 | (02) |