Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 31254 | IA |
NPI | 1033189535 |
---|---|
Provider Name | Tuvi Mendel |
First Address | Davenport, IA 52807-3471 |
Second Address | Davenport, IA 52807-3471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1141655 | (05) | IA |
G13569 | (02) | IA |