Healthcare Provider Details

I. General information

NPI: 1457264905
Provider Name (Legal Business Name): JOUDALLEE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E DONALD ST
WATERLOO IA
50703-1500
US

IV. Provider business mailing address

419 E DONALD ST
WATERLOO IA
50703-1500
US

V. Phone/Fax

Practice location:
  • Phone: 830-320-3852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOUD DIB
Title or Position: PROVIDER
Credential:
Phone: 830-320-3852