Provider Demographics
NPI:1417921230
Name:EASTERN IOWA FOOT SPECIALISTS P.C.
Entity Type:Organization
Organization Name:EASTERN IOWA FOOT SPECIALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-378-8280
Mailing Address - Street 1:1350 BOYSON RD
Mailing Address - Street 2:SUITE #D3
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2211
Mailing Address - Country:US
Mailing Address - Phone:319-378-8280
Mailing Address - Fax:319-378-8260
Practice Address - Street 1:1350 BOYSON RD
Practice Address - Street 2:SUITE #D3
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2211
Practice Address - Country:US
Practice Address - Phone:319-378-8280
Practice Address - Fax:319-378-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14000Medicare PIN
5280280001Medicare NSC