Provider Demographics
NPI:1164409140
Name:WAYMIRE, JOEL E (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:WAYMIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 73RD ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50312-1024
Mailing Address - Country:US
Mailing Address - Phone:515-224-4993
Mailing Address - Fax:515-224-1505
Practice Address - Street 1:974 73RD ST
Practice Address - Street 2:SUITE 30
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50312-1024
Practice Address - Country:US
Practice Address - Phone:515-224-4993
Practice Address - Fax:515-224-1505
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA25436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0042309Medicaid
IA1164409140Medicaid
A03328Medicare UPIN
IA0042309Medicaid