Provider Demographics
NPI:1336128453
Name:JONGEWAARD, WILLIAM R (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:JONGEWAARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1201 2ND AVE
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1960
Mailing Address - Country:US
Mailing Address - Phone:712-324-3298
Mailing Address - Fax:712-324-8233
Practice Address - Street 1:1201 2ND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1960
Practice Address - Country:US
Practice Address - Phone:712-324-3298
Practice Address - Fax:712-324-8233
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA29665208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0111369Medicaid
IA0111369Medicaid
IA48164Medicare ID - Type Unspecified