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General NPI Number Information
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NPI Number | 1326085739
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Entity Type | Organization
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Legal Business Name | FREDERICKSBURG FAMILY HEALTH CLINIC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 115 SCHULT RIDGE RD
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City | FREDERICKSBURG
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State | IA
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Zip | 50630-9582
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Country | US
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Telephone | 563-237-5316
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Fax | 563-237-6337
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Provider Business Mailing Address
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Address Line | 115 SCHULT RIDGE RD PO BOX 335
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City | FREDERICKSBURG
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State | IA
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Zip | 50630-9582
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Country | US
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Telephone | 563-237-5316
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Fax | 563-237-6337
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JOSEPH BERNARD PERAUD
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Credential | M.D.
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Telephone | 563-237-5316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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