Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2207 | IA |
N | 2080P0204X | Pediatric Emergency Doctor | 2207 | IA |
NPI | 1316043003 |
---|---|
Provider Name | Thomas Mcauliff |
First Address | Des Moines, IA 50305-4925 |
Second Address | Des Moines, IA 50314-2610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3044131 | (05) | IA |
E42088 | (02) | IA |