=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932478435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L.J. TWYNER M.D., PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2011
-----------------------------------------------------
Last Update Date | 12/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 1ST AVE E STE D
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50208-4255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-787-0343
-----------------------------------------------------
Fax | 641-787-0353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 1ST AVE E STE D
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50208-4255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-787-0343
-----------------------------------------------------
Fax | 641-787-0353
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAFAYETTE J TWYNER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 641-787-0343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20281
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------