Provider Demographics
NPI:1932478435
Name:L.J. TWYNER M.D., PC
Entity Type:Organization
Organization Name:L.J. TWYNER M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAFAYETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TWYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-787-0343
Mailing Address - Street 1:2501 1ST AVE E STE D
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-4255
Mailing Address - Country:US
Mailing Address - Phone:641-787-0343
Mailing Address - Fax:641-787-0353
Practice Address - Street 1:2501 1ST AVE E STE D
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-4255
Practice Address - Country:US
Practice Address - Phone:641-787-0343
Practice Address - Fax:641-787-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1538156138Medicaid