Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 03522 | IA |
NPI | 1043243009 |
---|---|
Provider Name | Molly Ann Camacho |
First Address | North Liberty, IA 52317-9468 |
Second Address | Coralville, IA 52241-2815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0429274 | (05) | IA |
33606 | WELLMARK BCBS (01) | IA |
F232553 | MIDLANDS CHOICE (01) | IA |
P00257946 | RAILROAD MEDICARE (01) | IA |