Healthcare Provider Details

I. General information

NPI: 1821086893
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 1ST ST E
INDEPENDENCE IA
50644-3116
US

IV. Provider business mailing address

1100 1ST ST E PO BOX 351
INDEPENDENCE IA
50644-3116
US

V. Phone/Fax

Practice location:
  • Phone: 319-334-2541
  • Fax: 319-334-7054
Mailing address:
  • Phone: 319-334-2541
  • Fax: 319-334-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: DUANE DONALD JASPER
Title or Position: PARTNER
Credential: M.D.,F.P.
Phone: 319-334-2541