Provider Demographics
NPI:1821086893
Name:MEDICAL ASSOCIATES OF INDEPENDENCE
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FP
Authorized Official - Phone:319-334-2541
Mailing Address - Street 1:1100 1ST ST E
Mailing Address - Street 2:PO BOX 351
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-3116
Mailing Address - Country:US
Mailing Address - Phone:319-334-2541
Mailing Address - Fax:319-334-7054
Practice Address - Street 1:1100 1ST ST E
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-3116
Practice Address - Country:US
Practice Address - Phone:319-334-2541
Practice Address - Fax:319-334-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty