Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 05130 | IA |
N | 111NI0900X | Internist | 05130 | IA |
NPI | 1003269325 |
---|---|
Provider Name | Ryan Elsey |
First Address | Dubuque, IA 52001-6389 |
Second Address | Dubuque, IA 52001-6389 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2016 |
Last Update Date | 06/04/2021 |