Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R-10093 | IA |
NPI | 1003222043 |
---|---|
Provider Name | Todd Eberle |
First Address | Des Moines, IA 50314-2613 |
Second Address | Des Moines, IA 50314-2613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 27/10/2014 |