Provider Demographics
NPI:1609108711
Name:FAMILY PHYSICIANS OF CEDAR RAPIDS, P.C.
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF CEDAR RAPIDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOEDKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-365-7581
Mailing Address - Street 1:811 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2421
Mailing Address - Country:US
Mailing Address - Phone:319-365-7581
Mailing Address - Fax:319-365-0163
Practice Address - Street 1:811 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2421
Practice Address - Country:US
Practice Address - Phone:319-365-7581
Practice Address - Fax:319-365-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty