Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 25191 | IA |
Y | 207RI0011X | Interventional Cardiology | MD-25191 | IA |
NPI | 1083696744 |
---|---|
Provider Name | Mark D Mcgaughey |
First Address | Des Moines, IA 50306-9170 |
Second Address | West Des Moines, IA 50266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 14/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060020321 | RR MEDICARE (01) | IA |
A02941 | (02) | IA |
CD4507 | RR MEDICARE GROUP (01) | IA |