Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 30827 | IA |
NPI | 1003818493 |
---|---|
Provider Name | Fawad Sabooh Zafar |
First Address | West Des Moines, IA 50265-1321 |
Second Address | West Des Moines, IA 50265-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1649223835 | (05) | IA |
1649223835 | WELLMARK BCBS (01) | IA |
340014274 | RAILROAD MEDICARE (01) | IA |
G23415 | (02) |