Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036.140178 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | DO04830 | IA |
NPI | 1093022873 |
---|---|
Provider Name | Ryan Travis Pokorney |
First Address | Bettendorf, IA 52722-7565 |
Second Address | Bettendorf, IA 52722-7564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2010 |
Last Update Date | 10/12/2019 |