Provider Demographics
NPI:1992836316
Name:FOOT AND ANKLE SPECIALISTS OF IOWA
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:NASSIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-363-8854
Mailing Address - Street 1:PO BOX 1431
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1431
Mailing Address - Country:US
Mailing Address - Phone:319-363-8854
Mailing Address - Fax:319-363-0807
Practice Address - Street 1:1215 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3016
Practice Address - Country:US
Practice Address - Phone:319-363-8854
Practice Address - Fax:319-363-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00481213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI21376Medicare PIN