Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 06769 | IA |
NPI | 1013011022 |
---|---|
Provider Name | Steven Douglas Vincent |
First Address | Iowa City, IA 52242-1001 |
Second Address | Iowa City, IA 52242-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1227567 | (05) | IA |
T01300 | (02) |