Organization Name: | CEDAR VALLEY PODIATRY, PC |
NPI Number: | 1003059841 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROXANNE M MASTELLER (OFFICE MANAGER) |
Mailing Address: | 700 11th St Charles City |
State: | IA US |
Postal Code: | 506163406 |
Phone Number: | 6412285578 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2009 |
NPI Last Update Date: | 04/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 00423 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |