Provider Demographics
NPI:1033273628
Name:DIB, JOUD GHASSOUB (MD)
Entity Type:Individual
Prefix:
First Name:JOUD
Middle Name:GHASSOUB
Last Name:DIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-287-9249
Practice Address - Street 1:419 EAST DONALD STREET
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1223
Practice Address - Country:US
Practice Address - Phone:319-236-1911
Practice Address - Fax:319-287-5832
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36972207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
421417307M4OtherJOHN DEERE HEALTH CARE
IA0749192Medicaid
30680OtherWELLMARK HEALTH CARE
421417307M4OtherJOHN DEERE HEALTH CARE
IAI19236Medicare PIN