Healthcare Provider Details

I. General information

NPI: 1710291505
Provider Name (Legal Business Name): DAVID H. SEGAL MD EASTERN IOWA BRAIN & SPINE SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 7TH STREET SE SECOND FLOOR
CEDAR RAPIDS IA
52401-2112
US

IV. Provider business mailing address

600 7TH STREET SE SECOND FLOOR
CEDAR RAPIDS IA
52401-2112
US

V. Phone/Fax

Practice location:
  • Phone: 319-423-7200
  • Fax: 319-247-0011
Mailing address:
  • Phone: 319-423-7200
  • Fax: 319-247-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number38342
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1710291505
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
IdentifierDQ8568
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerRR MEDICARE
# 3
Identifier1710291505
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BCBS

VIII. Authorized Official

Name: DR. DAVID HARVEY SEGAL
Title or Position: SURGEON/OWNER
Credential: M.D.
Phone: 319-423-7200