Healthcare Provider Details

I. General information

NPI: 1720284128
Provider Name (Legal Business Name): JUSTIN W. SMOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR INTERNAL MEDICINE, SE615 GH
IOWA CITY IA
52242
US

IV. Provider business mailing address

200 HAWKINS DR INTERNAL MEDICINE, SE615 GH
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-384-6501
  • Fax: 319-356-3086
Mailing address:
  • Phone: 319-384-6501
  • Fax: 319-356-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39024
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD-39024
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: