Healthcare Provider Details

I. General information

NPI: 1841985553
Provider Name (Legal Business Name): MAUREEN AZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 W 4TH ST
WATERLOO IA
50702-2801
US

IV. Provider business mailing address

927 W 4TH ST
WATERLOO IA
50702-2801
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-6107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number137452
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: