Healthcare Provider Details

I. General information

NPI: 1184629073
Provider Name (Legal Business Name): IOWA PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S CLARK ST STE 200
CARROLL IA
51401-3047
US

IV. Provider business mailing address

405 S CLARK ST STE 200
CARROLL IA
51401-3047
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-0040
  • Fax:
Mailing address:
  • Phone: 712-792-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number22537
License Number StateIA

VIII. Authorized Official

Name: DR. ERIC L PAULSON
Title or Position: MD
Credential:
Phone: 712-792-0040