MEDICARE: DERMATOLOGY CLINIC OF IOWA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	33078	IA

General Provider Information

NPI Number	:	1962610725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY CLINIC OF IOWA PC

Provider Business Mailing Address
First Line	:	1815 FIRST AVE SE
Second Line	:	SUITE 200
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402
Country	:	US
Telephone Number	:	319-363-0474
Fax Number	:	319-363-2170

Provider Business Practice Location Address
First Line	:	1815 1ST AVE SE
Second Line	:	SUITE 200
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5434
Country	:	US
Telephone Number	:	319-363-0474
Fax Number	:	319-363-2170

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BARBARA ANN PFEIFFER
Credential	:	CMA
Telephone Number	:	319-363-0474

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	05/27/2010

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