Basic Information
| Provider Information | |||||||||
| NPI: | 1174726962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAHL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503125305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152373974 | ||||||||
| FaxNumber: | 5158832692 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W LINCOLNWAY ST | ||||||||
| Address2: | SUITE WCO | ||||||||
| City: | JEFFERSON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501291645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153862240 | ||||||||
| FaxNumber: | 5153862280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 04092 | IA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.