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General NPI Number Information
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NPI Number | 1770036691
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Entity Type | Organization
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Legal Business Name | CENTERS FOR ALLERGY, ASTHMA AND IMMUNE DISORDERS PC
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 804 KENYON RD
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City | FORT DODGE
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State | IA
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Zip | 50501-5742
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Country | US
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Telephone | 515-574-6830
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Fax | 515-574-6097
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Provider Business Mailing Address
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Address Line | 804 KENYON RD
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City | FORT DODGE
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State | IA
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Zip | 50501-5742
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Country | US
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Telephone | 515-574-6830
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Fax | 515-574-6097
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANCISCO MIR GARCIA PERALTA
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Credential | M.D.
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Telephone | 515-570-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 29873
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License Number State | IA
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