Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 32318 | IA |
NPI | 1336147800 |
---|---|
Provider Name | Dr. Jeffrey Michael Nassif |
First Address | Cedar Rapids, IA 52406-3178 |
Second Address | Cedar Rapids, IA 52403-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0167577 | (05) | IA |
44214 | BLUE CROSS/BLUE SHIELD (01) | IN |
G49810 | (02) | IA |