Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 37186 | IA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 37186 | IA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301089444 | MI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MT184001 | PA |
NPI | 1467663674 |
---|---|
Provider Name | Dr. Wahid Alfonse Riad Zaky |
First Address | Waterloo, IA 50703-4407 |
Second Address | Waterloo, IA 50703-4407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2007 |
Last Update Date | 30/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0076372 | (05) | IA |