| NPI | 1033183884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID DWIGHT COSTER Chair 641-236-4323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 26205) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 18984) |
| 208800000X Urology (Licence: IA 28246) | |
| 363A00000X Physician Assistant (Licence: IA 001646) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 001335) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2010-05-11 |