| NPI | 1942614367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA RAY MODLIN Owner 515-244-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IA 073866) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2014-06-13 |