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General NPI Number Information
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NPI Number | 1396771622
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Entity Type | Organization
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Legal Business Name | JERROLD V. FLATT D.O., P.C.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 1301 PENNSYLVANIA AVE STE 316
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City | DES MOINES
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State | IA
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Zip | 50316-2366
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Country | US
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Telephone | 515-262-0996
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Fax | 515-264-1009
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Provider Business Mailing Address
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Address Line | 1301 PENN AVE STE 316
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City | DES MOINES
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State | IA
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Zip | 50316-2366
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Country | US
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Telephone | 515-262-0996
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Fax | 515-264-1009
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JERROLD VERLIN FLATT
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Credential | D.O.
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Telephone | 515-262-0996
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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 | 01819
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License Number State | IA
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