Basic Information
| Provider Information | |||||||||
| NPI: | 1043573025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEVERMAN | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | MITCHELL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E J AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | GRUNDY CENTER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506382004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198246945 | ||||||||
| FaxNumber: | 3198246947 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E J AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | GRUNDY CENTER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506382004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198246945 | ||||||||
| FaxNumber: | 3198246947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2012 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2012020299 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 2012020299 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | DO-04776 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | DO-04776 | IA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.