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General NPI Number Information
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NPI Number | 1679877393
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Entity Type | Organization
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Legal Business Name | HAMID R. AMJADI, D.O.
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 3741 PHEASANT LN
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City | WATERLOO
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State | IA
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Zip | 50701-5215
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Country | US
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Telephone | 319-233-3611
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Fax | 319-233-0669
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Provider Business Mailing Address
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Address Line | PO BOX 2818
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City | WATERLOO
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State | IA
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Zip | 50704-2818
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Country | US
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Telephone | 319-233-3044
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Fax | 319-233-0722
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Authorized Official
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Title or Position | OWNER
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Name | DR. HAMID R AMJADI
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Credential | D.O.
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Telephone | 319-233-3044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 02883
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License Number State | IA
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