Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 27222 | IA |
NPI | 1053380907 |
---|---|
Provider Name | Yuly Goldin |
First Address | Fort Dodge, IA 50501-5742 |
Second Address | Fort Dodge, IA 50501-5742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 18/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0275503 | (05) | IA |
340004864 | RAILROAD MEDICARE (01) | IA |
4409 | MIDLAND'S CHOICE (01) | IA |
A16459 | (02) |