Healthcare Provider Details

I. General information

NPI: 1881126852
Provider Name (Legal Business Name): JEFFREY RHODUS WUNDERLICH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5074
US

IV. Provider business mailing address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5074
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7909
  • Fax: 319-368-7737
Mailing address:
  • Phone: 319-369-7909
  • Fax: 319-368-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberMD-50112
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD-50112
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-50112
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-50112
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: