Healthcare Provider Details

I. General information

NPI: 1689628117
Provider Name (Legal Business Name): ASHAR AFZAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3254 KIMBALL AVE
WATERLOO IA
50702-5739
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-7246
  • Fax: 319-235-3017
Mailing address:
  • Phone: 319-235-5390
  • Fax: 319-233-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34325
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34325
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34325
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: