Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | A05676 | IA |
NPI | 1225011174 |
---|---|
Provider Name | Joseph S Ferezy |
First Address | Waukee, IA 50263-8653 |
Second Address | Waukee, IA 50263-8653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 19/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42-1400619 | TAX ID (01) | IA |