=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043407562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUBUQUE RHEUMATOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2007
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 JFK RD SUITE B
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52002-3883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-583-4848
-----------------------------------------------------
Fax | 563-690-1304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 JFK RD SUITE B
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52002-3883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-583-4848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GEORGE B ISAAC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 563-583-4848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 32128
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------