Provider Demographics
NPI:1821237942
Name:JEFFREY LENZ MD PC
Entity Type:Organization
Organization Name:JEFFREY LENZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-223-0066
Mailing Address - Street 1:1235 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265
Mailing Address - Country:US
Mailing Address - Phone:515-223-0066
Mailing Address - Fax:515-223-7848
Practice Address - Street 1:1235 8TH STREET
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265
Practice Address - Country:US
Practice Address - Phone:515-223-0066
Practice Address - Fax:515-223-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA02221Medicare UPIN