Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 17076 | IA |
NPI | 1093702854 |
---|---|
Provider Name | Rudolph P Galask |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0063958 | (05) | IA |
06395 | WELLMARK BCBS (01) | IA |
A00820 | (02) |