MEDICARE: ELEANOR LISA LAVADIE-GOMEZ M.D.

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	38217	IA

General Provider Information

NPI Number	:	1538367925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR LISA LAVADIE-GOMEZ M.D.

Provider Business Mailing Address
First Line	:	400 S CLINTON ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4105
Country	:	US
Telephone Number	:	319-338-0581
Fax Number	:	319-887-4975

Provider Business Practice Location Address
First Line	:	400 S CLINTON ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4105
Country	:	US
Telephone Number	:	319-338-0581
Fax Number	:	319-887-4975

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	10/24/2024

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