Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 18194 | IA |
NPI | 1033109400 |
---|---|
Provider Name | Richard Lee Zeaske |
First Address | Cedar Rapids, IA 52403-2464 |
Second Address | Cedar Rapids, IA 52403-2464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1240457 | (05) | IA |
A03104 | (02) |