Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 30597 | IA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 30597 | IA |
NPI | 1417055641 |
---|---|
Provider Name | Stephen Michael Feltz |
First Address | Des Moines, IA 50314-3044 |
Second Address | Des Moines, IA 50314-3044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 18/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0123554 | (05) | IA |
G04796 | (02) | IA |