Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 21075 | IA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 21075 | IA |
NPI | 1043271406 |
---|---|
Provider Name | Raul C Banagale |
First Address | Sioux City, IA 51104-3734 |
Second Address | Sioux City, IA 51104-3734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 02/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1149385 | (05) | IA |