| NPI | 1083144406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY LYNN CARLSON Podiatrist 515-205-5635 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: UT 7054576-0501) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2017-06-18 |