Basic Information
| Provider Information | |||||||||
| NPI: | 1033273628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIB | ||||||||
| FirstName: | JOUD | ||||||||
| MiddleName: | GHASSOUB | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2758 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192355390 | ||||||||
| FaxNumber: | 3192879249 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 EAST DONALD STREET | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507031223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192361911 | ||||||||
| FaxNumber: | 3192875832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 36972 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 421417307M4 | 01 | JOHN DEERE HEALTH CARE | OTHER | 0749192 | 05 | IA | MEDICAID | 30680 | 01 | WELLMARK HEALTH CARE | OTHER |