MEDICARE: MR. JEFFREY J LENZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	23540	IA

General Provider Information

NPI Number	:	1124082706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY J LENZ MD

Provider Business Mailing Address
First Line	:	1235 8TH ST
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2623
Country	:	US
Telephone Number	:	515-223-0066
Fax Number	:	515-223-7848

Provider Business Practice Location Address
First Line	:	1235 8TH ST
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2623
Country	:	US
Telephone Number	:	515-223-0066
Fax Number	:	515-223-7848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	11/19/2010

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