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General NPI Number Information
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NPI Number | 1558533265
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Entity Type | Organization
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Legal Business Name | NORTHWEST IOWA EAR NOSE AND THROAT, PC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 920 GRAND AVE
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City | SPENCER
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State | IA
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Zip | 51301-3641
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Country | US
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Telephone | 712-262-8120
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Fax | 712-262-7028
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Provider Business Mailing Address
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Address Line | PO BOX 1194
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City | SPENCER
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State | IA
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Zip | 51301-1194
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Country | US
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Telephone | 712-262-8120
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Fax | 712-262-7028
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. DANIEL L JORGENSEN
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Credential | MD
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Telephone | 712-262-8120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 21909
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License Number State | IA
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